An evidence-based, structured, expert approach to selecting essential indicators of primary care quality

Abstract

Background The purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a targeted set of such measures, prioritized according to their contribution and value to primary care. Methods We adapted ProMES to select and rank existing primary care measures according to value to the primary care clinic. Nine subject matter experts (SMEs) consisting of clinicians, hospital leaders and national policymakers participated in facilitated expert elicitation sessions to identify objectives of performance, corresponding measures, and priority rankings. Results The SMEs identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted, currently existing measures from three different data sources for primary care. One indicator, Team 2-Day Post Discharge Contact Ratio, was selected as an indicator of both team partnerships and technical quality. Indicators were prioritized according to value using the contingency functions developed by the SMEs. Conclusion Our article provides an actionable guide to applying ProMES, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures. Future work should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as operationalizating measures to be meaningful and interpretable across health care settings.

Regular measurement is essential but insufficient to improve quality of healthcare

“…Advances in information technology over the past decades, along with a growing demand for accountability and regular measurement of quality of care, have resulted in a proliferation of indicators, tools, and approaches to measuring the performance of health systems 34. Routine health information systems (RHIS) that capture high quality data to facilitate regular use of data to monitor realtime trends in healthcare processes and outcomes are essential.…”

Clinical deterioration as a nurse sensitive indicator in the out‐of‐hospital context: A scoping review

“…Whilst other authors have sought indicators of quality in the primary health care context (Hysong et al., 2022; Lukewich et al., 2022; McCullough et al., 2023; Metusela et al., 2022; Veillard et al., 2017), this review focused on clinical deterioration which has not been well researched in the out‐of‐hospital context. Moreover, a recent literature review of the effectiveness of nurses in primary care did not identify any measures or studies focusing on clinical deterioration as a concept or nurse specific indicator (Lukewich et al., 2022), including recognition, reaction and relaying.…”

“…Whilst other authors have sought indicators of quality in the primary health care context (Hysong et al, 2022;Lukewich et al, 2022;McCullough et al, 2023;Metusela et al, 2022;Veillard et al, 2017), Whilst this review sought to explore the care provided by nurses, it is also important to acknowledge that care not done can also contribute to clinical deterioration. 'Missed care' has been conceptualised as an example of errors of omission in nursing care (Kalisch et al, 2009) and covers 'any aspect of required patient care that is omitted (either in part or as a whole) or delayed' (Kalisch et al, 2009(Kalisch et al, p.1509.…”

Ambulatory Care Coordination Data Gathering and Use

“…13 A body of research aimed to optimize care coordination demonstrated metrics collected at point of care to evaluate care coordination efficiency, as well. 14,15 In a Veterans Health Administration program aimed to integrate care coordination, home telehealth monitoring, and disease management, authors concluded that an enterprise-wide, systems approach to home telehealth implementation was an appropriate and cost-effective way to manage chronic care patients. 16 However, a detailed search of the literature did not produce studies that described the data needs and sources used by ambulatory nurse care coordinators.…”

“…Care coordination was facilitated by synthesis of internal and external data 13 . A body of research aimed to optimize care coordination demonstrated metrics collected at point of care to evaluate care coordination efficiency, as well 14,15 . In a Veterans Health Administration program aimed to integrate care coordination, home telehealth monitoring, and disease management, authors concluded that an enterprise-wide, systems approach to home telehealth implementation was an appropriate and cost-effective way to manage chronic care patients 16 .…”