Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review

Abstract

Background: Health system performance indicators are widely used to assess primary health care (PHC) performance. Despite the numerous tools and some convergence on indicator criteria, there is not a clear understanding of the common features of indicator selection processes. We aimed to review the literature to identify papers that document indicator selection processes for health system performance indicators in PHC. Methods: We searched the online databases Scopus, Medline and CINAHL, as well as the grey literature, without time restrictions, initially on 31 July 2019 followed by an update 13 November 2020. Empirical studies or reports were included if they described the selection of health system performance indicators or frameworks, that included PHC indicators. A combination of the process focussed research question and qualitative analysis meant a quality appraisal tool or assessment of bias could not meaningfully be applied to assess individual studies. We undertook an inductive analysis based on potential indicator selection processes criteria, drawn from health system performance indicator appraisal tools reported in the literature. Results: We identified 16,503 records of which 28 were included in the review. Most studies used a descriptive case study design. We found no consistent variations between indicator selection processes of health systems of high income and low- or lower-middle income countries. Identified common features of selection processes for indicators in PHC include literature review or adaption of an existing framework as an initial step; a consensus building process with stakeholders; structuring indicators into categories; and indicator criteria focusing on validity and feasibility. The evidence around field testing with utility and consideration of reporting burden was less clear. Conclusion: Our findings highlight several characteristics of health system indicator selection processes. These features provide the groundwork to better understand how to value indicator selection processes in primary health care.

The Performance of Primary Healthcare in China: The Need for a Systematic Design for Improvement Comment on "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China"

“…With the improvement of PHC facilities and human resources, the key to making improvements in the performance of PHC in China is to enhance the capacity and motivation of family doctors. 7 The “PHC quality and performance measurement” which focused in Rasooly and colleagues’ article is an important incentive affecting the capacity and motivation of such family doctors. Moreover, when one takes a high-level view of the Mainland Chinese PHC system, in addition to the problems identified by Rasooly and colleagues (eg, frontline clinicians from indicator planning, a lack of transparent reporting, and a rigid organizational culture with limited bottom-up feedback), there are yet further and deeper issues that must be considered.…”