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

Area of Science:

• Primary Care Management
• Health Services Research
• Quality Improvement

Background:

• Performance indicators for medical care quality are often controversial, particularly those linked to pay-for-performance models.
• Recent healthcare reforms in Portugal have introduced performance indicators that have generated significant debate.

Purpose of the Study:

• To achieve consensus among family medicine opinion leaders on essential performance indicators for managing Family Health Units in Portugal.
• To guide the evaluation of primary care practices within the Portuguese healthcare system.

Main Methods:

• An online Delphi study involving 89 primary care specialists was conducted.
• Experts rated proposed indicators on validity, reliability, feasibility, and sensitivity to change using a Likert scale.
• Twenty-seven experts participated in the second round, reaching a high degree of consensus on key indicators.

Main Results:

• Experts proposed a mix of existing and novel performance indicators.
• Thirty-nine existing indicators were identified as currently in use in Portugal.
• High consensus was achieved for indicators assessing the volume of clinical and administrative acts, and the clinical demographic profile.
• Fifty new indicators were suggested, with five categories reaching high consensus and three achieving low consensus.

Conclusions:

• Performance indicators for practice management should prioritize the assessment of clinical and administrative activity volume.
• These indicators must be contextualized by available human and financial resources.
• The demographic characteristics of the patient population should also inform performance indicator evaluation.