Performance measurement systems in primary health care: a systematic literature review

Performance measurement systems (PMS) are increasingly recognized as essential tools in healthcare services. However, there remains a significant gap in the literature regarding their development, implementation, and impact on primary health care (PHC). This study aims to systematically review peer-reviewed literature to identify and analyze existing constructs, methodologies, and challenges associated with PMS in primary care settings worldwide.

This systematic review follows the PRISMA guidelines regarded as the gold standard for evidence synthesis in scientific and grey literature. The quality of the selected studies was assessed using the Rosalind Franklin Qualitative Research Appraisal Instrument (RF-QRA), focusing on transferability, reliability, credibility, and confirmability.

From an initial pool of 167 articles, 14 studies were selected for in-depth analysis. These studies highlighted several challenges, including difficulties in evaluating PMS post-implementation within primary care units, limited evidence on the longitudinal monitoring of performance indicators, and inconsistencies in methodological approaches. The findings also revealed that regional, operational, and cultural contexts influenced the most PMS adaptations.

This systematic review offers a comprehensive diagnosis of the best PMS models implemented globally over the past five years, emphasizing heterogeneity, diversification, and reliability. The findings underscore the potential for PMS to inform public policies to achieve high-performance primary healthcare systems and enhance decision-making processes at both operational and managerial levels.