Table 3 Overview of framework for monitoring the impact, performance and capacity of PHC, indicators and data sources
From: Creating performance intelligence for primary health care strengthening in Europe
Domain | Subdomain | Feature | Indicator title | Expected data sources |
|---|---|---|---|---|
Primary care structures | Primary care governance (GOV) | GOV1. Primary care priorities | Primary care strategy | policy; key informant |
GOV2. Accountability arrangements | Primary care mandate | key informant | ||
Primary care resources | key informant | |||
Public health services mandate | report; key informant | |||
GOV3. Stakeholder participation and engagement | Roles of professional associations of generalist medical practitioners | key informant | ||
Roles of professional associations of nurses and midwives in primary care | key informant | |||
Roles of patient and/or consumer groups | report; survey; key informant | |||
GOV4. Quality assurance mechanisms | Quality assurance of health professionals | policy; key informant | ||
Quality assurance of facilities | policy; key informant | |||
Development of primary care clinical practice guidelines | policy; survey; key informant | |||
Patient rights and choice | policy; report; key informant | |||
Primary care financing (FIN) | FIN1. Primary care expenditure | Total primary health care expenditure as a share of total health expenditure | database | |
Domestic primary health care expenditure | database | |||
Capital and recurrent expenditure arrangements | key informant | |||
FIN2. Payment methods in primary care | Provider payments | report; survey; key informant | ||
Employment status and remuneration of generalist medical practitioners | survey; report; key informant | |||
Pay-for-performance | survey; key informant | |||
Support for caregivers/family carers | report; key informant | |||
Benefit package | Services included in the health benefit package | report; survey; key informant | ||
Primary care workforce (WRK) | WRK1. Primary care workforce planning | Type of primary care health professionals | policy; key informant | |
Scope of practice for primary care health professionals | policy; key informant | |||
Incentives for recruitment and retention in underserved areas | policy; key informant | |||
Retraining programme for specialist medical practitioners/narrow specialists | key informant; database | |||
Workforce registry with information on primary care professionals | survey; key informant | |||
WRK2. Financial status of general practitioners | Relative financial status of generalist medical practitioners | database | ||
WRK3. Primary care workforce availability | Age distribution of generalist medical practitioners | database | ||
WRK4. Academic status of primary care | General practice/family medicine undergraduate/bachelor education | key informant | ||
General practice/family medicine postgraduate education | key informant | |||
General practice/family medicine postgraduate clinical practice | key informant | |||
General practice/family medicine specialization among medical students | database | |||
Nurses working in primary care undergraduate/bachelor and postgraduate education | key informant | |||
Professional journal on general practice/family medicine | key informant | |||
Primary care information system (INF) | INF1. Data capture | Electronic health records system | survey; key informant | |
Electronic health record system linked to clinical systems | survey; key informant | |||
INF2. Aggregation of data | Patient registries | survey; key informant | ||
INF3. Patient platforms | Use of mHealth in primary care | survey; key informant | ||
Primary care medicines (MED) | MED1. Availability of medicines | Reimbursement eligibility scheme for outpatient medicines | policy; survey; key informant | |
Availability of essential medicines for primary care | survey; database; expert consensus | |||
Primary care diagnostics (DGN) | DGN1. Laboratory | Availability of laboratory tests in primary care | survey; database; expert consensus | |
DGN2. Imaging | Availability of diagnostic imaging in primary care | survey; database; expert consensus | ||
Primary care technologies (TCH) | TCH1. Basic technology | Availability of equipment in primary care | survey; database; expert consensus | |
Primary care facility infrastructure (STR) | STR1. Amenities | General service readiness at facility-level | key informant | |
Model of primary care | Primary care selection of services (SEL) | SEL1. Identifying needs | Population stratification | key informant |
SEL2. Preventive care | Counselling services | key informant | ||
Population based screening | key informant | |||
Individual risk assessments/stratification | key informant | |||
Vaccination services | survey; report; key informant | |||
SEL3. Diagnostic procedures | Diagnostic exams | key informant | ||
Final diagnosis in primary care | key informant | |||
SEL4. Treatment | Prescribing authority of generalist medical practitioners | policy; report; key informant | ||
SEL5. Management of diseases | Follow-up services in primary care | key informant | ||
Other services | key informant | |||
SEL6. Patient engagement | Self-management and health literacy in primary care | key informant | ||
Primary care design (DES) | DES1. Referral system | Gatekeeping system | survey; report; key informant | |
Referral protocol from primary care to higher levels of care | policy; survey; key informant | |||
Reply and discharge protocol from higher levels of care to primary care | policy; key informant | |||
DES2. Care pathways | Shared care pathways | report; policy; key informant | ||
DES3. Flexible access modes | Different access modes | survey; expert consensus | ||
DES4. Shared care plans | Developing shared care plans | survey; expert consensus | ||
Primary care workforce organization (ORG) | ORG1. Practice population | Choice of generalist medical practitioner | survey; report; key informant | |
Patient list system | policy; report; key informant | |||
Primary care health professionals’ density | database; report | |||
Caseload of generalist medical practitioner | database; survey | |||
ORG2. Out-of-hours care | Opening hours in primary care | report; policy; key informant | ||
Out-of-hours in primary care | survey; key informant | |||
ORG3. Primary care teams | Types of primary care facilities | policy; key informant | ||
Shared practices in primary care | policy; report; database | |||
Coordination within primary care | policy; survey; report; expert consensus | |||
Existence of care coordinator | policy; survey; report; expert consensus | |||
ORG4. Collaboration of primary care with other professionals | Cooperation with specialist medical practitioners | survey; expert consensus | ||
Coordination across sectors | policy; survey; report; expert consensus | |||
Primary care services management (MAN) | MAN1. Primary care staffing | Autonomy in staffing of medical staff | key informant | |
MAN2. Managing primary care facilities | Degree of autonomy in budgeting | key informant | ||
Health care technology management | survey; key informant | |||
MAN3. Strategic planning | Population health management | key informant | ||
Primary care quality improvement (IMP) | IMP1. National or regional primary care performance assessment | Accountability for performance | policy; survey; report; key informant | |
Patient experience measures | policy; survey; report; key informant | |||
Job satisfaction | survey; key informant | |||
IMP2. Practice-level quality improvement mechanisms | Quality of care processes | policy; report; key informant | ||
Safety incidents reporting | policy; report; key informant | |||
IMP3. External accountability for quality of care | External accountability for quality of care delivered by generalist medical practitioners | key informant | ||
IMP4. Continuous professional development | Continuous professional development opportunities | database; expert consensus | ||
Care contact | Utilization (UTL) | UTL1. Consultation rate | Overall utilization of primary care services | database; survey |
UTL2. Preventive care and diagnostic services | Influenza vaccination coverage | database; report; expert consensus | ||
HPV vaccination coverage | database; survey; expert consensus | |||
Diabetic education | database; survey; expert consensus | |||
Counselling services for tobacco cessation | survey | |||
National cancer screening programmes targeting the general population | database; survey; expert consensus | |||
Individual risk assessments | database; expert consensus | |||
Tuberculosis preventive care and diagnostic services | database | |||
WHO recommended rapid test as the initial diagnostic test for tuberculosis | database | |||
Continuity of primary care (CON) | CON1. Treatment | Hypertension treatment coverage | database; survey; expert consensus | |
Tuberculosis treatment coverage | database | |||
Depression treatment coverage | database; expert consensus | |||
CON2. Follow-up care | Hypertension follow-up | database; survey; expert consensus | ||
Diabetes monitoring | database; expert consensus | |||
Chronic obstructive pulmonary disease follow-up | database; expert consensus | |||
Post-natal care | database; expert consensus | |||
Depression treatment follow-up | database; expert consensus | |||
CON3. Longitudinal continuity of care | Stability of patient–generalist medical practitioner relationship | survey | ||
CON4. Informational continuity of care | Medical record keeping | survey; expert consensus | ||
Incoming clinical information procedures | survey; expert consensus | |||
Generalist–specialist medical practitioner communication | survey; expert consensus | |||
Generalist medical practitioner-social services | survey; expert consensus | |||
Coordination of care across settings (COR) | COR1. Transition management | Referral feedback to primary care | survey; expert consensus | |
Comprehensiveness of primary care (COP) | COP1. Resolution capacity of generalist medical practitioner | General medical practitioner consultations without referral | database; expert consensus | |
People-centredness of primary care (PCC) | PCC1. Patient experience | Patient satisfaction | report; survey | |
PCC2. Shared decision-making | Care and treatment shared decision-making | database; survey; report | ||
PCC3. Patient engagement | Patient reporting opportunity to ask questions | database; survey; report | ||
Patient reporting enough time with doctor | database; survey; report | |||
Patient reporting easy to understand explanations | database; survey; report | |||
Primary care outputs | Access to primary care services (ACC) | ACC1. Availability and affordability of primary care services | Same day appointments | survey |
Waiting time for appointment | survey; report | |||
Access barriers due to treatment costs | database; survey; report | |||
Access to medicines | database | |||
ACC2. Acceptability | Patient reported acceptability of primary care services | survey | ||
Responsiveness of primary care (RES) | RES1. Resolving capacity of primary care | Composite measure | database; survey; report; key informant | |
Safety of primary care (SAF) | SAF1. Medical errors | Correct diagnosis | reports; expert consensus | |
Incident reporting | reports; expert consensus | |||
SAF2. Medicine safety | Overall volume of antibiotics prescribed | database | ||
Medication review | survey; expert consensus | |||
Effectiveness of primary care services (EFF) | EFF1. Effective management and control of diseases | Control of blood pressure among people treated for hypertension | database; expert consensus | |
Control of blood glucose among people treated for diabetes | database; expert consensus | |||
Tuberculosis detection and treatment | database | |||
Cancer survival rates | database | |||
Health system outcomes | Quality (QLY) | QLY1. Quality of care for chronic conditions | Hospital admissions for chronic conditions | database |
Avoidable complications | database | |||
Notified tuberculosis cases lost to follow-up | report | |||
Stage at diagnosis for cancer | database | |||
QLY2. Prescribing in primary care | Secondary prevention/high-risk control | survey; expert consensus | ||
Tuberculosis and rifampicin/multidrug resistant tuberculosis treatment in primary care | database | |||
Access to palliative care | report; database | |||
Equity (EQT) | EQT1. Equitable delivery of primary care services | Composite measure | database; survey; report; key informant | |
Efficiency (EFC) | EFC1. Unnecessary procedures | Unnecessary duplication of medical tests | survey; expert consensus | |
Health outcomes | Health status and well-being (HSW) | HSW1. Burden of disease and risk factors | Risk factors – smoking | database |
Risk factors – alcohol | database | |||
Risk factors – overweight and obesity | database | |||
Morbidity | database; survey | |||
Disability adjusted life years | database | |||
HSW2. Mortality | Standardized death rates | database | ||
Premature mortality | database |