Health Policy 80 (2007) 314–327
Panning for gold: An evidence-based tool for assessment of performance indicators in primary health care Roshan Perera a,∗ , Tony Dowell a , Peter Crampton b , Robin Kearns c b
Department of Primary Health Care and General Practice, Wellington School of Medicine and Health Sciences, University of Otago, P.O. Box 7343 Wellington, New Zealand Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand c School of Geography and Environmental Science, University of Auckland, Auckland, New Zealand
Abstract It is important that debate occurs between theorists, policy makers, clinicians and service end-users to develop agreement over suitable and appropriate indicators for primary health care. A formal accounting of the relative strengths and weaknesses of any proposed indicator will enable sector commentators from a variety of viewpoints to discuss the relative merits of individual indicators, to understand the political and pragmatic reasons for their inclusion in any set of indicators and to trace the likely organisational impact of any given indicator. This paper details the development of an indicator appraisal tool that combines the assessment of scientiﬁc evidence with contextual considerations from the perspective of both the policy environment and the primary health care sector. The use of the tool is discussed in the context of the proposed national implementation of a set of performance indicators in New Zealand. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Performance indicators; Primary health care; Health services research
1. Introduction The past several decades have seen considerable effort directed towards improving systems of accountability and quality within health care systems within a number of countries. More recently increased emphasis on primary health care funding and service delivery have produced a greater focus on the development of ∗ Corresponding author. Tel.: +64 4 3855995x4758; fax: +64 4 3855539. E-mail addresses: firstname.lastname@example.org, email@example.com (R. Perera).
performance indicators in primary health care. A proliferation of performance measures and ad hoc indicator sets, often lacking a sound theoretical basis for their selection and development, have led many authors to provide deﬁnitions and criteria to help in the development of evidence-based indicator sets suitable for a primary health care setting [1–19]. The adoption of evidence and consensus-based indicators for primary health care in various national frameworks, however, has not been without controversy and criticism, and debate about their use and value [20–22]. Virtually any proposed indicator set has met with criticism, generally in one or more of three broad strands:
0168-8510/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2006.03.011
R. Perera et al. / Health Policy 80 (2007) 314–327
suitability for purpose, technical qualities and impact upon individuals or organizations . Critics often occupy particular roles in the primary health care sector, and tensions between primary health care and policy communities appear to leave a Hobson’s choice between alternatives of organisational paralysis or pragmatic implementation of controversial proposals. Conceptually, the rationale for the introduction of performance indicators assumes that their presence in an organisation will foster a change in the quality of processes within that organisation, which will ultimately produce better outcomes at either a population or cost saving level. This model is predicated on the assumption that the introduced performance indicators possess the necessary attributes to provide a measure that reliably predicts either health outcomes or economic outcomes of value. These necessary attributes include the supporting evidence of best practice and established...
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