Developing indicators and measures of high-quality for Australian general practice

Background: Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. Methods: We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. Results: A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. Conclusions: The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally

Assessing the quality of patient-reported measures (PRMs) used in primary health care : development of a PRM compendium

Background: Patient-reported measures (PRMs) of outcomes and experience are an important aspect of providing high quality primary health care (PHC). PRMs provide insight to healthcare professionals, practices and primary health networks about patient experience, needs and expectations, areas of importance to patients, as well as highlight areas of achievement and gaps. There are numerous PRMs available. However, the quality of these PRMs in the context of development and validation is largely unknown and many are not readily accessible. Aim/Objectives: As part of a wider project, Quality Equity and Systems Transformation in Primary Health Care (QUEST PHC), to develop a tool for measuring high quality in Australian general practice, we aimed to assess the quality of PRMs used in PHC to provide information about their purpose, quality and accessibility. Methods: A systematic review of PRMs used in PHC in Australia and overseas within the last 10 years was conducted between July and August 2021. Of the 519 papers identified, 58 were included after screening, and information about the PRMs was extracted by three reviewers. Each PRM was assessed by two reviewers for relevance to Australian PHC. Ninety-two PRMs were finally included for critical appraisal. Development and validation papers were sourced and each PRM was assessed for quality of development, content validity and validation based on a modified COSMIN framework by five reviewers. Results: A compendium of 92 PRMs has been developed consisting of a description of each PRM, critical appraisal of its quality, a repository of the PRMs freely available and the weblinks of PRMs that require permission for access. Implications: This compendium adds to the knowledge base of PRMs used in PHC. It has the potential to inform health care professionals’ choice of PRMs to use, and enhance patient experience and outcomes through quality improvement

Quality, Equity and Systems Transformation in Primary Health Care (QUEST PHC): Project Report

In Australia as internationally, rising health costs and health inequity are major challenges. Strong primary health care systems are well evidenced to address both costs and equity of health outcomes. Australia is engaged in a number of initiatives aiming to improve the quality of primary health care and in particular general practice. At a regional level Primary Health Networks (PHNs) work with general practices to collect and monitor a range of data and a national process for data collection, storage and analysis is currently being planned. However, there is no consensus as to what defines high quality in general practice in this country. The Western Sydney PHN (WentWest) supports a number of practices engaged in practice transformation towards high quality models of care including Patient Centred Medical Home (PCMH) models. In partnership with the Department of General Practice at Western Sydney University, WentWest sought to develop an evidence based suite of indicators and measures of high quality general practice, utilising the data they obtain from their practices. Discussion with other Primary Health Networks revealed similar interests, so we partnered in the first instance with two other Primary Health Networks in our region (Nepean Blue Mountains and South Western Sydney) to test the face validity of the indicators and measures developed with WentWest. This report presents the research described above which was funded by WentWest and by the Ainsworth Foundation. We plan future content validation of the tool with a larger number of Primary Health Networks, aiming to build a model that will enable measurement of high quality general practice in the Australian context