Diverse community leaders’ perspectives about quality primary healthcare and healthcare measurement: Qualitative community-based participatory research

Kathleen A. Culhane-Pera, Shannon L. Pergament, Maiyia Y. Kasouaher, Andrew M. Pattock, Naima Dhore, Cindy N. Kaigama, Marcela Alison, Michael Scandrett, Mai See Thao, David J. Satin

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Healthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Redressing healthcare inequities, including measurement of and reimbursement for healthcare quality, requires partnering with communities historically excluded from decision-making. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view quality healthcare and financial reimbursement based on quality metric scores. Methods: A Community Engagement Team consisting of one community member from each of seven urban communities —Black/African American, Lesbian-Gay-Bisexual-Transgender-Queer-Two Spirit, Hmong, Latino/a/x, Native American, Somali, and White—and two community-based researchers conducted listening sessions with 20 community leaders about quality primary healthcare. Transcripts were inductively analyzed and major themes were identified. Results: Listening sessions produced three major themes, with recommended actions for primary care clinics. #1: Quality Clinics Utilize Structures and Processes that Support Healthcare Equity. #2: Quality Clinics Offer Effective Relationships, Education, and Health Promotion. #3: Funding Based on Current Quality Measures Perpetuates Health Inequities. Conclusion: Community leaders identified ideal characteristics of quality primary healthcare, most of which are not currently measured. They expressed concern that linking clinic payment with quality metrics without considering social and structural determinants of health perpetuates social injustice in healthcare.

Original languageEnglish (US)
Article number226
JournalInternational journal for equity in health
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
We thank people who contributed greatly to the study. Misty Blue and Mo Mike participated in planning the study and conducting the listening sessions. Community leaders, both those who wanted to remain anonymous and those who consented to be named: Nimo Afyare, Roxanne Anderson, Nathaniael Beske, Janeth Guerra de Patino, Kim Hayden, Natalie Johnson Lee, Clarence Jones, Nicholas Metcalf, Maria L. Moya, Carmenza Preus, Kimberia Sherva, Blanca Svedberg, Demetria Turnage, and PaHoua Vang. In addition, we want to thank members of the Minnesota Safety Net Coalition?s Quality Measurement Enhancement Project (QMEP), who participated in the study design and focus group question development, and were the first recipients of the results.

Funding Information:
This work was supported by the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion’s State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke (DP14-1422PPHF14) cooperative agreement with the Minnesota Department of Health. This publication represents the views of the authors and does not represent CDC’s position or policy. In addition, Minnesota Community Care and the American Heart Association provided some funding for the study.

Publisher Copyright:
© 2021, The Author(s).


  • Community-based participatory research (CBPR)
  • Healthcare inequities
  • Pay-for-performance
  • Primary care quality metrics
  • Value-based payments
  • United States
  • Humans
  • African Americans
  • Community-Based Participatory Research
  • Delivery of Health Care
  • Female
  • Primary Health Care
  • Qualitative Research
  • Quality of Health Care

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Journal Article


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