Piloting Structural Equation Modeling for Fundamental Care Decision-Making Across Healthcare Settings

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Abstract
Predictive modeling has advanced healthcare management by informing operational and strategic decisions; however, such models often exclude the fundamental care elements that shape patients' experiences, thereby limiting person-centered, quality-driven decisions. This gap is addressed by piloting a predictive model grounded in the Fundamentals of Care (FoC) Framework, which captures how system-level and policy-level conditions (Context of Care) influence care outcomes (Integration of Care) through the clinician–patient Relationship. A cross-sectional, exploratory design was implemented across Spain (hospital-based care, n = 55) and Australia (community-based care, n = 32). A culturally adapted, 41-item patient-reported experience measure was developed to operationalize the FoC Framework’s three core dimensions. Structural relationships were tested using Consistent Partial Least Squares Structural Equation Modeling to assess model feasibility. Results indicate that the Context of Care significantly predicted Relationship in both countries (Spain: β = 0.33; Australia: β = 0.68), which strongly predicted Integration of Care (Spain: β = 0.84; Australia: β = 0.92), fully mediating the effect of Context, which had no direct influence on Integration. Findings highlight a consistent structural pathway: Context of Care → Relationship → Integration of Care. This pilot demonstrates the feasibility of integrating patient-reported experience data into predictive modeling grounded in fundamental care delivery theory, offering transferable insights into how system- and policy-level conditions shape care quality through the Relationship dimension. The model supports early-stage decision-making tools for quality improvement, workforce planning, and system design, emphasizing the importance of a Context of Care that enables clinician-patient Relationships to achieve effective Integration of Care.

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