title: Identifying performance indicators for family practice: assessing levels of consensus.
abstract: OBJECTIVE
  To identify performance indicators for family practice that focus on organizational structures and clinical processes of care, to review evidence linking indicators to patient outcomes, to have providers select indicators they consider important for performance assessment, and to obtain provider views on challenges to developing a performance assessment system.
  
  
  METHODS
  Review of published and unpublished literature and contact with international experts resulted in a list of 131 structure and process indicators and associated evidence. This information was used in a two-round modified Delphi consensus process, which was followed by interviews with each of the 12 consensus panel members.
  
  
  METHODS
  Ontario family practices.
  
  
  METHODS
  Eleven family physicians and one nurse practitioner from Ontario.
  
  
  METHODS
  Survey package with 131 indicators and associated evidence was mailed to panel members who rated each of the indicators on a Likert scale from 1 (not at all important for performance assessment) to 9 (essential for performance assessment). Interviews were conducted with panel members to discuss indicator feasibility and data sources. Consensus score and median importance score for each indicator were main outcome measures; interviews identified barriers to performance assessment.
  
  
  RESULTS
  Fifty-one indicators achieved high consensus, 19 moderate consensus, and 38 low consensus. Clinical indicators that reached a high level of consensus were generally supported by grade A or B recommendations and level I to III evidence. Clinical indicators that achieved moderate consensus often had fair support in the literature. Low consensus was mainly associated with fair or equivocal evidence. During follow-up interviews, consensus panel members voiced frustration with inconsistencies in the evidence and practice guidelines upon which indicators are often based, and with poor transfer of patient information between health care providers. Lack of detail in patient care documentation and inconsistent documentation were mentioned frequently as threats to data quality.
  
  
  CONCLUSIONS
  Despite challenges to performance measurement noted by the panel, study results support the continued development, refinement, and testing of primary care performance indicators.
authors.affiliation: Department of Health Policy, Management and Evaluation, University of Toronto, Ontario. jan.barnsley@utoronto.ca
authors.forename: Jan
authors.initials: J
authors.lastname: Barnsley
authors.forename: Whitney
authors.initials: W
authors.lastname: Berta
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cockerill
authors.forename: Judith
authors.initials: J
authors.lastname: MacPhail
authors.forename: Eugene
authors.initials: E
authors.lastname: Vayda
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D016730:Program Development; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*