Table 3 Measure structures of performance measurement systems in primary care for projects studying Performance Measurement Systems

T—Performance evaluation and ranking of regional primary health care and public health Systems in Iran

A—Rashidian et al

Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA) and Data Envelopment Analysis (DEA)

2

4

39

1. Death, communicable and non communicable disease

1. Workforces and other resources

1. Risk Factors and Health Behaviors

1. Services Covarage

T—Primary health care performance: a scoping review of the current state of measurement in Africa

A—Bresick, G et al

Primary Healthcare Performance Initiative (PHPI)

5

15

38

1. Availability of Effective PHC Services;

2. People-Centered Care

3. Efetive service covarege

4. Health Status

5. Morbidity;

6. Mortality

1. Information Systems;

2. Provider Knowledge

1. Health Financing

2. Funds

1. Workforce

1. Responsiveness to People

1. Governance & Leadership

2. Organization and Management

1. Drugs & Supplies;

2. Facility Infrastructure;

3. Access

4. Equity

1. Efficiency

2. Resilience of Health Systems

1. Adjustment to Population Health Needs;

2. Access

3. Equity

T—Evidence gap map of performance measurement and management in primary healthcare systems in low-income and middle-income countries

A—Munar, W et al

Performance Measurement and Management (PMM) and Evidence Gap Maps (EGMs)

5

15

22

1. Quality of care process

improvements;

2. Adherence to recommended practice or guidelines;

3. Patient satisfaction;

4. Perceived quality of care

1. Patient satisfaction;

2. Health Status Outcomes: (1) Physical health

3. Health Status Outcomes: (2) Psychological health

4. Community participation

1. work morale;

2. Stress, Burnout and Sick leave

3. Staff Turnover;

4. Attitudes, beliefs, perception;

5. Skills and competencies

6. Changes in organizational culture

7. Health Behaviors: (1) Adherence by patients

1. Changes in organizational culture

2. Unintended outcomes

1. Access to primary care services

1. workload

1. Health Behaviors: (2) Health seeking behaviors

2. Utilization of specific services

3. Coverage of specific services or interventions

4. Access to primary care services

5. Equity effects

T—PHC Progression Model: a novel mixed-methods tool for measuring primary health care system capacity

A—Ratcliffe, HL et al

PHC Progression Model

3

9

32

1. Quality management infrastructure

1. Surveillance;

2. Innovation and Learning

3. Civil registration and vital statistics

4. Health management information systems

5. Personal care records

6. Training

7. Information system use

1. Facility budgets

2. Financial management information system

3. Salary payment

1. Community engagement;

2. Empanelment

3. Team-based care organisation

1. Density and distribution

2. Community health workers

3. Proactive population outreach

1. PHC policies

2. Social accountability

3. Facility management capability and leadership

1. Stock-out of essential medicines and consumable commodities;

2. Basic equipment;

3. Diagnostic supplies

4. Facility Density

5. Facility amenities

6. Standard safety precautions and equipment

7. Local priority setting

8. Availability of laboratory tests in primary care;

9. Availability of diagnostic imaging in primary care;

10. Availability of equipment in primary care

11. General service readiness at facility-level;

1. Performance measurement and management

1. Priority Setting

T—Quality of primary care from patients' perspective: a cross sectional study of outpatients' experience in public health facilities in rural Malawi

A—Dullie, L et al

Malawian version of the primary care assessment tool (PCAT-Mw)

5

5

29

1. Is there a complaints / suggestion box at this HC?

2. Does this HC seem interested in the quality of care that you get from that specialist or hospital?

3. Does this HC do surveys of patients to see if services are meeting the needs of the people?

1. Do you think the staff at this HC understands what you say or ask?

2. Are your questions answered in a way that you understand?

3. Does this HC know your complete medical history?

4. Does this HC know about your work or employment?

1. Does this HC get opinions and ideas from people or organizations with knowledge to help provide better health care? E.g. the local health committee, churches, other organizations?

1. Is the staff friendly and approachable?

2. Does this HC know you very well as a person, rather than as someone with a medical problem?

3. Does this HC know who lives with you?

1. Does this HC know what the results of the visit were?

2. After you went to the specialist or hospital, did this HC talk with you about what happened at that visit?

1. Do you think this HC knows about the important health problems of your area?

1. When this HC is closed on Saturday and Sunday and you get sick, would someone from here see you the same day?

2. When the HC is closed and you get sick during the night, would someone from here see you that night?

3. Does this HC give you enough time to talk about your problems or worries?

4. Checking hearing

5. Dental check-up – checking and cleaning your teeth;

6. Treatment by dental therapist eg extraction of bad teeth;

7. Counseling for mental health problems;

8. Plastering of fractures;

9. Treatment of ingrown toe nails or removing part of a nail

10. Advice on wearing reflectors when walking on the road at night;

11. How to prevent hot burns;

12. Advice about appropriate exercise for you;

13. Advice on how to prevent accidental falls;

14. Ways to handle family conflict; arguments; disagreements (that may arise from time to time);

15. Possible exposure to harmful substances in your home, at work or in your area e.g. paraffin; pesticides?

T—Creating performance intelligence for primary health care strengthening in Europe

A—Barbazza, E et al

Focus Groups and Survay for monitoring indicators

6

26

139

1. Quality assurance of health professionals;

2. Quality assurance of facilities;

3. Patient experience measures;

4. Job satisfaction;

5. Quality of care processes;

6. External accountability for quality of care delivered by generalist medical practitioners;

7. Patient satisfaction;

8. Patient reporting enough time with doctor;

9. Correct diagnosis;

10. Incident reporting

11. Medication review;

12. Unnecessary duplication of medical tests;

1. Retraining programme for specialist medical practitioners/narrow specialists;

2. General practice/family medicine undergraduate/bachelor education;

3. General practice/family medicine postgraduate education;

4. General practice/family medicine postgraduate clinical practice;

5. General practice/family medicine specialization among medical students;

6. Nurses working in primary care undergraduate/bachelor and postgraduate education;

7. Professional journal on general practice/family medicine;

8. Electronic health records system;

9. Patient registries;

10. Use of mHealth in primary care;

11. Self-management and health literacy in primary care;

12. Referral protocol from primary care to higher levels of care;

13. Resposta e protocolo de alta dos níveis superiores de atenção à atenção primária;

14. Patient list system;

15. Health care technology management;

16. Safety incidents reporting;

17. Continuous professional development opportunities;

18. Diabetic education;

19. Counselling services for tobacco cessation;

20. Medical record keeping;

21. Incoming clinical information procedures;

22. Generalist–specialist medical practitioner communication;

23. General medical practitioner consultations without referral

1. Total primary health care expenditure as a share of total health expenditure;

2. Domestic primary health care expenditure;

3. Capital and recurrent expenditure arrangements;

4. Provider payments;

5. Employment status and remuneration of generalist medical practitioners;

6. Relative financial status of generalist medical practitioners;

7. Reimbursement eligibility scheme for outpatient medicines;

8. Degree of autonomy in budgeting;;

9. Population health management;

10. Access barriers due to treatment costs

1. Roles of professional associations of generalist medical practitioners;

2. Roles of professional associations of nurses and midwives in primary care;

3. Roles of patient and/or consumer groups;

4. Support for caregivers/family carers

5. Individual risk assessments;

6. Stability of patient–generalist medical practitioner relationship;

7. Generalist medical practitioner-social services;

8. Patient reported acceptability of primary care services;

9. Risk factors – smoking;

10. Risk factors – alcohol;

11. Risk factors – overweight and obesity;

12. Morbidity;

13. Disability adjusted life years;

1. Patient rights and choice

2. Type of primary care health professionals;

3. Workforce registry with information on primary care professionals;

4. Age distribution of generalist medical practitioners;

5. Population based screening;

6. Choice of generalist medical practitioner;

7. Caseload of generalist medical practitioner;

8. Existence of care coordinator;

9. Patient reporting opportunity to ask questions;

10. Patient reporting easy to understand explanations;

1. Primary care strategy;

2. Development of primary care clinical practice guidelines

3. Primary care mandate;

4. Public health services mandate;

5. Incentives for recruitment and retention in underserved areas;

6. Population stratification;

7.Prescribing authority of generalist medical practitioners;

8. Follow-up services in primary care;

9. Follow-up services in primary care—Other services;

10. Developing shared care plans;

11. Coordination within primary care;

12. Cooperation with specialist medical practitioners;

13. Coordination across sectors;

14. Autonomy in staffing of medical staff;

15. National cancer screening programmes targeting the general population;

16. WHO recommended rapid test as the initial diagnostic test for tuberculosis;

17. Referral feedback to primary care;

18. Care and treatment shared decision-making;

19. Overall volume of antibiotics prescribed

1. Quality assurance of facilities;

2, Primary care resources;

3. Electronic health record system linked to clinical systems;

4. Gatekeeping system;

5. Different access modes;

6. Primary care health professionals’ density

7. Opening hours in primary care;

8. Out-of-hours in primary care

9. Types of primary care facilities;

10. Same day appointments;

11. Waiting time for appointment;

1. Pay-for-performance

2. Accountability for performance

3. Overall utilization of primary care services

4. Composite measure

5. Composite measure

1. Services included in the health benefit package;

2. Scope of practice for primary care health professionals;

3. Availability of essential medicines for primary care;

4. Counselling services;

5. Individual risk assessments/stratification;

6. Vaccination services;

7. Diagnostic exams

8. Final diagnosis in primary care

9. Shared care pathways;

10.Shared practices in primary care;

11. Influenza vaccination coverage;

12. HPV vaccination coverage;

13.Tuberculosis preventive care and diagnostic services;

14. Hypertension treatment coverage;

15. Tuberculosis treatment coverage;

16. Depression treatment coverage;

17. Hypertension follow-up;

18. Diabetes monitoring;

19. Chronic obstructive pulmonary disease follow-up

20. Post-natal care

21. Depression treatment follow-up

22. Access to medicines

23. Control of blood pressure among people treated for hypertension

24. Control of blood glucose among people treated for diabetes;

25. Tuberculosis detection and treatment;

26. Cancer survival rates

27. Hospital admissions for chronic conditions;

28. Avoidable complications;

29. Tuberculosis and rifampicin/multidrug resistant tuberculosis treatment in primary care;

30. Access to palliative care;

31. Standardized death rates;

32. Premature mortality

T—Development of a performance measurement system for general practitioners' office in China's primary healthcare

A—Ruan, WJ et al

Index pool: Delphi method and survay

3

3

42

1. satisfaction;

2. quality of service

3. satisfaction of medical staff;

4. client satisfaction

1. construction of information system;

2. regional healthcare information system;

3. capacity building of team;

4. health education and advisory services;

5. outpatient services

1. sources of funding

1. Collaborative community-based services;

1. culture building of team

1. team building;

2. mode of operation;

3.government input;

4. public provisioning of health services;

3. synergy of government;

4. health management service;

5. effective contract rate

1. appearance of the office;

2. naming;

3. office size;

4. facilities & equipment;

5. interior layout;

6. staffing;

7. appointment service;

1. income;

2. income of basic health care;

3. income of public provisioning of health services;

4. compliance rate;

5. rate of contract renewal;

6. contract rate for key populations;

1. mode of operation;

2. basic health care;

3. contract service of family doctor;

4. telemedicine services;

5. general medical services;

6. emergency medical services;

7. pharmaceutical delivery;

8. outpatient services;

9. service for long-term prescriptions;

10. rate of hypertension control;

11. rate of diabetes control;

T—Improving the quality of primary care by allocating performance-based targets, in a diverse insured population

A—Peled, R., Porath, A. & Wilf-Miron, R

Performance Measurement System (PMS) by HEDIS Measures and Technical Resources

6

6

25

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

It is not clear or there is no evidence in the writing of the article about indicators of this level

T—A conceptual framework for measuring community health workforce performance within primary health care systems

A—Agarwal et al

The Community Health Worker Performance Measurement Framework

7

19

46

1. #/% of supervisory visits that met the quality criterion;

2. #/% of CHWs who correctly identified the case/health problem (as per items in a checklist);

3. #/% of CHWs who correctly addressed (treated) the identified health problem (as per items in a checklist);

4. #/% of referred clients seen at receiving service (health facility) that is seen back at referring service (CHW) with complete counter-referral information (counter-referral)

1.#/% of supervisors trained in management and supervision of CHWs;

2. #/% of national/sub-national/facility/community meetings in which data (from standardized reporting platforms etc.) are discussed/reviewed;

3. #/% of CHWs who have access to the client data they have collected (for follow-up) in the last 6 months;

4. #/% of CHWs who have received initial training;

5. #/% of CHWs who have received follow-up training in the last 2 years;

6. #/% of CHWs who have completed the certification program

7. #/% of CHWs who have passed knowledge/competency tests (following training);

8. #/% of CHWs who express that they feel confidence in their abilities to provide health education

9. #/% of CHWs who express confidence in their abilities to deliver basic healthcare services;

10. #/% of CHWs who submitted reports in the last month;

11. #/% of CHW reports submitted that were complete/did not have missing information;

12. In the last 3 months, #/% of CHWs who have reported on their activities;

13. #/% of women/clients who report they trust the health information provided by the CHW;

1. #/% of CHWs who have received their stipend in the last month

1. #/% of target communities/populations that have an assigned CHW;

2. # of planning/review meetings held at the level of the local government to discuss CHW program performance;

3. #/% of CHWs who expressed satisfaction with the community support they receive;

4. #/% of CHWs who expressed satisfaction with the support they receive from health facility staff;

5. #/% of community members that know the name of the community CHWs;

6. #/% of community members who can name at least 3 services that the CHW provides;

7. #/% of women/households who express satisfaction with services they received from the CHW in the last 3 months;

8. #/% of women who report that in their interaction with the CHW they felt humiliated or disrespected (scale 1–5);

1. #/% of health workers (CHWs/supervisors/health facility staff) who have access to client data AND who report using the data to make decisions about their provision of services;

2. #/% of CHWs who have been selected in alignment with selection criteria;

3. # of CHWs who have been selected/recruited;

4. CHW's Motivation—Composite metric;

5. Empowerment—Composite metric;

1. Ratio of CHWs to supervisors;

2. Average # of visits per supervisor to monitor/support CHW activities in the last month;

3. #/% of CHWs who received a supervisory visit in the last 1–3 months that includes review of reports and data collected;

4. Average # of supervisory contacts (in-person visits, phone calls, text messages, etc.) per CHW;

5. #/% of CHWs who have received a specific non-financial incentive;

6. #/% of clients that completed the referral at the health facility (referral completion)

1. #/% of CHWs with all the key stock commodities in the last reporting period

1. # of planning/review meetings held at the level of the local government to discuss CHW program performance;

2. Average time from onset of symptom to first contact with CHW;

3. ##/% of CHWs who reported on their activities in the last month;

4. # of days CHW has performed at least one CHW responsibility in the last month;

5. % of individuals referred by CHW to the health facility per 100 clients seen (and subset by reasons for referral)

6. Average # of referrals made per CHW in the last month;

1. Average # of home visits made by CHWs in the last month (indicator to be disaggregated by type of home visit—i.e., sick child visit, antenatal care)

2. #/% of households who received at least one visit by a CHW in the last 3 months;

3. #/% of women/clients who report they trust the treatment services provided by the CHW

T—A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic

A—Amer et al

Balanced Scorecard (BSC)

13

45

797

1. Complains;

2. Errors, accidents and complications;

3. Improvement;

4. Internal assessment

5. Patient satisfaction

6. Revenue vs. Expenditure;

1.Standards and regulations;

2. Communications;

3. HCW feedback;

4. HCW training;

5. Patient information;

6. Records;

7. Reports;

1. Expenditures and costs

2. Expenditures and costs 1;

3. Expenditures and costs 1–2;

4. Expenditures and costs 2;

5. Revenue;

6. Revenue vs. Expenditure;

1. Community role and connections;

2. Market share;

3. Patient loyalty;

4. Response to patients;

1. Female consideration;

2. HCW engagement and motivation;

3. HCW loyalty;

4. HCW satisfaction;

5. Staff knowledge, attitude, and practices;

6. Staffing;

1. HCW turnover;

2. Margins;

1. supplies and equipments;

2. Technology/ information system;

3. Volume, infrastructure and access;

4. Waste management

1. Efficiency, utilization and productivity;

2. Mortality

3. Number of admissions, visits and disease scores;

4. Services time measuring;

5. aiting time;

1. Infection control;

2. Length of Stay;

3. Medications;

4. Occupancy;

5. Products and Services;

6. Researches/Scientific productivity;

T—Population segments as a tool for health care performance reporting: an exploratory study in the Canadian province of British Columbia

A—Langton et al

System of cost and access indicators by segment for logistic regressions

5

5

14

1. Mean Costs ($): Total FP (family physician) Care (any location)

2. Cost of Specialist Care;

3. Mean Costs ($): Inpatient Hospital Care

4. Mean Costs ($): Day surgeries;

5. ED (emergency department) visit (estimated facility cost);

6. Mean Costs ($):Prescription Medicines (PharmaCare + Private paid)

7. Total Costs (Total FP Care, inpatient hospital care, prescription medicines, plus medical & surgical specialist care, day surgeries and ED visits);

1. Continuity of Care: UPC Index (Mean, range 0–1);

1. Total FP (family physician) Care (any location)

2. ED (emergency department) visit (estimated facility cost);

3. Access outside office hours: % patients with FP billing outside office hours;

1. Coordination: % patients seeing < 5 FP physicians

1. Prescription Medicines (PharmaCare + Private paid);

2. FP (family physician) visits (any location);

3. Hospital separations per 100 population;

4. ED (emergency department) Visits per 100 population;

5. Filled classes of medication

T—Evidence-based indicators for the measurement of quality of primary care using health insurance claims data in Switzerland: results of a pragmatic consensus process

A—Blozik et al

IQ (Indicators Qualiy)

6

6

24

1. Proportion of insured persons aged 65 years or older with prescription of potential inappropriate medications (PIM);

1. Medication costs per insured person;

2. Costs per daily dose in specific ATC groups relevant in primary care;

1. Proportion of insured persons aged 65 year or older with at least one chronic condition who were hospitalised for fracture near the pelvic joint;

1. Number of emergency hospital admissions per 1000 insured persons;

2. Disease-specific hospitalisation rate of insured persons with the Pharmacy Cost Group “respiratory disease”;

3. Proportion of insured persons with antidiabetic medication receiving which HbA1c controls (number of controls per year);

4. Hospitalisation rate of insured persons with antidiabetic medication;

1. Costs per daily dose in specific ATC groups relevant in primary care;

2. Proportion of prescriptions of inefficient me-too medications;

3. Number of different primary care physicians consulted by an individual insured person;

4. Number of different specialist physicians consulted by an individual insured person;

5. Number of prescriptions of anxiolytics, sedatives or hypnotics;

6. Number of prescriptions of non-steroidal anti-inflammatory drugs (NSAIDs);

7. Proportion of insured persons aged 65 years or older with polymedication;

8. Proportion of insured persons aged 65 year or older with reimbursed influenza vaccination;

9. Proportion of insured persons receiving long term therapy of systemic corticosteroids;

10. Proportion of insured persons with antidiabetic medication receiving which an ophthalmologic control within 15 months;

11. Proportion of insured persons with antidiabetic medication receiving control of lipid values per year;

12. Proportion of insured persons with antidiabetic medication receiving control of kidney values per year;

13. Proportion of insured persons with hospitalization for myocardial infarction receiving acetylsalicylic acid (ASS);

14. Proportion of insured persons with hospitalization for myocardial infarction receiving statins

15. Proportion of insured persons with hospitalization for stroke receiving ASS;

16. Proportion of insured persons with hospitalization for stroke receiving statins

T—Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile

A—Varela et al

Multimorbidity Patient-Centered Care Model (MPCM)

4

4

17

1. Local training plan of MPCM for new employees;

2. Alert system informing PHC teams of patients consulting at emergency room and hospitalization;

3. Phone counseling;

1. Borrowed money or sold something to afford the costs of care/treatment

1. Clinical Pharmacist;

2. High-complexity primary physician;

3. Case Manager;

4. Transition Nurse;

1. Decision makers support (PHC director and managers);

2. Leader for the implementation of the MPCM at the PHC;

3. Implementation of an induction plan;

1. Rescue after hospital discharge;

1. Adult population stratified by risk, available and with patients ID;

2. Unified drug prescription;

3. Integrated multimorbidity scheduled appointments;

4. Individualized Care Plans;

5. Continuity of care with a professional from the team;

6. Transition care

T—Health facility management and primary

health care performance in Uganda

A—Kim et al., 2022

PRIME-Tool adapted from the World Management Survey

5

3

27

1. The cleanliness in the health facility?

2. How much do you trust the skills and abilities of the health workers at this facility?

3. The level of respect the provider showed you?

4. Overall, taking everything into account, how would you rate the quality of care you received at this facility?

1. Age;

2. Sex of household member;

3. Quintile of wealtha;

4. Highest level of school attended;

5. Marital Status;

6. Neighborhood;

7. Region;

8. Has any insurance or is a member of a mutual health;

9. How easy or difficult was it for you to follow the provider’s advice?

10. How likely are you to return or bring your children to this facility for health care in the future?

1. The provider’s ability to explain things in a way that you could understand?

1. Managing Authority;

1. Type of Facility;

2. Essential drug index (EDI);

3. Equipment index (EI)

1. The length of wait time at the facility before you were seen?

1. Services Covered by Insurance;