Codeveloping a Set of Quality of Care Indicators for People Living With Multiple Long-Term Conditions in Primary...

Quality indicators in primary care remain predominantly disease-specific and professionally defined, with limited incorporation of what matters most to people living with multiple long-term conditions (MLTCs) and their caregivers. Existing frameworks and quality standards provide important conceptual direction, but few produce a pragmatic set of ready-to-use indicators.

This study aims to codevelop a disease-agnostic set of quality of care indicators with people living with MLTCs, caregivers, and health care professionals, including preliminary operational specifications to support future feasibility testing and service improvement in general practices within the National Health Service in England.

This protocol describes a 3-round modified RAND/UCLA Appropriateness Method (RAM) study. The first round will evaluate the importance of candidate indicators through an online questionnaire to an expert panel of patients, caregivers, and health care professionals. Indicators without agreement or requiring revision will proceed to a structured consensus meeting (round 2) with subsequent rerating rounds (round 3) for feasibility and measurability.

As of July 2026, 10 patient and caregiver participants and 12 health care professionals have consented to join an expert panel. The expected RAM study completion, including data analysis and reporting, is early 2027. Fifty-four candidate quality indicators have been generated through triangulation of findings between a scoping review of published quality indicators in MLTCs and a qualitative study with 21 patients and caregivers with lived experience of MLTCs. Ongoing patient and public involvement and engagement with four community partners have further informed the study design, interpretation of multistage findings, and refinement of candidate indicators. The indicators have been mapped to a structure-process-outcome quality framework and will be taken forward into a modified 3-staged RAM study.

This study will generate a co-designed and implementation-oriented set of primary care quality indicators for MLTCs. The final indicator set is intended to support future measurement, quality improvement, and later field testing in real-world primary care systems.