Performance indicators for clinical practice management in primary care in Portugal: Consensus from a Delphi study

Abstract

Background: Performance indicators assessing the quality of medical care and linked to pay for performance may cause disagreement. Portuguese indicators included in recent health care reform are controversial. Objectives: To obtain consensus from opinion leaders in family medicine regarding the performance indicators for practice management used in the evaluation of Family Health Units in Portugal. Methods: Eighty-nine specialists in primary care were invited to answer the following question in an online Delphi study: ' Which performance indicators should be assessed regarding the organization and management of clinical practice in primary care in Portugal? 'A Likert scale was used to evaluate validity, reliability, feasibility and sensitivity to change. Twenty-seven experts participated in the second round and achieved a high degree of consensus. Eight categories were created for analysis. Results: The experts suggested the use of existing indicators as well as new indicators. Thirty-nine indicators suggested by the experts are currently in use in Portugal. The assessment of the number of clinical acts performed, the number of administrative acts, and evaluation of the clinical demographic profi le achieved a high degree of consensus. The expert panel suggested fi fty new indicators. Five categories of these new indicators had a high degree of consensus, and three categories had a low degree of consensus. Conclusion:The expert panel recommended that performance indicators of practice management should fi rst assess the quantity of clinical and administrative activities undertaken. These indicators must take into account the human and fi nancial resources available to the clinic and its demographic context.

A valiação do desempenho médico e necessidades educacionais em cuidados de saúde primários em Portugal: para além do SIADAP

“…2 A lack of attention to the context of the clinic (urban or rural, rich or poor community) has also been a source of criticism of the current indicators used to assess the quality of practice management. 3 Data abstracted from charts can indicate high quality performance by doctors in areas such as cardiovascular risk factor management 4 and in diabetes care. 5 However no single source of data is adequate for performance assessment.…”