Protocol for a Delphi consensus study to select indicators of high-quality general practice to achieve Quality Equity and Systems Transformation in Primary Health Care (QUEST-PHC) in Australia

Abstract

Background High-quality general practice has been demonstrated to provide cost-effective, equitable health care and improve health outcomes. Yet there is currently not a set of agreed comprehensive indicators in Australia. We have developed 79 evidence-based indicators and their corresponding 129 measures of high-quality general practice. This study aims to achieve consensus on relevant and feasible indicators and measures for the Australian context. Methods This Delphi consensus study, approved by WSU Human Research Ethics Committee, consists of three rounds of online survey with general practice experts including general practitioners, practice nurses and primary health network staff. The identified indicators and measures are grouped under an attribute framework aligned with the Quadruple Aim, and further grouped under structures, processes and outcomes according to the Donabedian framework. Participants will rate each indicator and measure for relevance and feasibility, and provide comments and recommendations of additional indicators or measures. In the last round, participants will also be asked their views on the implementation of a quality indicator tool. Each indicator and measure will require ≥70% agreement in both relevance and feasibility to achieve consensus. Aggregated ratings will be statistically analysed for response rates, level of agreement, medians, interquartile ranges and group rankings. Qualitative responses will be analysed thematically using a mixed inductive and deductive approach. Discussion This protocol will add to the current knowledge of the translation of performance guidelines into quality practice across complex clinical settings and in a variety of different contexts in Australian general practice. The Delphi technique is appropriate to develop consensus between the diverse experts because of its ability to offer anonymity to other participants and minimise bias. Findings will contribute to the design of an assessment tool of high-quality general practice that would enable future primary health care reforms in Australia.

Developing a quality framework for community pharmacy: a systematic review of international literature

“…Donabedian proposed that structure, process and outcomes are closely linked and influence each other, and his three components are the basis for many quality frameworks. [19][20][21][22] In 2001, the US Institute of Medicine (IOM) developed a healthcare quality framework that involved six dimensions (ie, safety, effectiveness, patient-centredness, timely, efficient and equitable). 23 The IOM's framework has been widely recognised, and since its inception, different organisations have proposed quality frameworks that often use a combination of these six dimensions.…”

Reducing uncertainty in Delphi surveys: A case study on immigration to the EU

“…Much of the guidance for Delphi surveys over the past four decades has originated from fields other than migration -particularly healthcare, which often employs Delphi surveys for different purposes than those of this study (Flostrand, Pitt, and Bridson 2020). Previous studies in these fields have aimed to select health indicators based on expert consensus or to identify criteria for measuring health-related outcomes (see, for example, Page et al 2015;Lau et al 2022;Jünger et al 2017).…”