Essential Indicators of Quality in Primary Care Settings: An Evidence-Based, Structured, Expert Approach

Abstract

Backgrond and Objective: Primary health care has a central role in the workings of the health care system and health of the American public. Thus, a high-performing, high-quality primary care system is essential. As a result, measurement frameworks are needed to assess the quality of the infrastructure, workforce configurations, and processes available in primary care practices due to the complexity of primary care. As part of a larger project supported by AHRQ (grant no. 1 R01 HS 025982), our research team reports the use of an evidence-based approach to compile a targeted set of existing care measures. These measures are prioritized according to their overall contribution and value to primary care. Within this paper, we describe the process by which the performance measures were selected and present the final set of measures resulting from the process. Methods and Results: We adapted The Productivity Measurement and Enhancement System, or ProMES, to select and rank existing primary care measures according to value to the primary care clinic. ProMES is a comprehensive performance measure development approach firmly grounded in motivational theory and performance measurement that uses expert elicitation to identify objectives of performance, corresponding measures and priority rankings. A design team of Nine subject matter experts (SMEs) identified three fundamental objectives for delivery of high-quality primary care, themed around access, patient-healthcare team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted measures that already exist in three different data sources for primary care. One indicator, Team 2 Day Post Discharge Contact Ratio, was selected as an indicator for both Objective 2 and 3. Indicators were prioritized according to value using the contingency functions developed by the design team. Finally, the SMEs proposed nine new indicators of quality not currently in existence to address critical gaps in measuring the primary care domain. Implications and Future Directions: Performance measures selected as part of our modified-ProMES process assist in the implementation of targeted care quality measures prioritized in accordance to their value in primary care . Our measure set provides an actionable catalogue of measures that can serve as a first step toward interoperability of electronic health record systems. Future work toward this goal should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as the best way to operationalize these measures for teams working in complex and shifting situations (e.g., rotating team members).