Performance indicators for clinical practice management in primary care in Portugal: consensus from a Delphi study.
BACKGROUND
Performance indicators assessing the quality of medical care and linked to pay for performance may cause disagreement. Portuguese indicators included in recent health care reform are controversial.


OBJECTIVE
To obtain consensus from opinion leaders in family medicine regarding the performance indicators for practice management used in the evaluation of Family Health Units in Portugal.


METHODS
Eighty-nine specialists in primary care were invited to answer the following question in an online Delphi study: 'Which performance indicators should be assessed regarding the organization and management of clinical practice in primary care in Portugal?' A Likert scale was used to evaluate validity, reliability, feasibility and sensitivity to change. Twenty-seven experts participated in the second round and achieved a high degree of consensus. Eight categories were created for analysis.


RESULTS
The experts suggested the use of existing indicators as well as new indicators. Thirty-nine indicators suggested by the experts are currently in use in Portugal. The assessment of the number of clinical acts performed, the number of administrative acts, and evaluation of the clinical demographic profile achieved a high degree of consensus. The expert panel suggested fifty new indicators. Five categories of these new indicators had a high degree of consensus, and three categories had a low degree of consensus.


CONCLUSIONS
The expert panel recommended that performance indicators of practice management should first assess the quantity of clinical and administrative activities undertaken. These indicators must take into account the human and financial resources available to the clinic and its demographic context.
Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho , Braga , Portugal.
Miguel
M
Basto-Pereira
Sara Isabel Félix
SI
Furtado
Ricardo Jorge Pereira
RJ
Silva
Francisco
F
Fachado González
Tito Manuel
TM
Vara Fernandes
Jaime
J
Correia de Sousa
John
J
Yaphe
D000328:Adult; D032921:Consensus; D003697:Delphi Technique; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive
Delphi method; Performance indicators; Portugal; primary healthcare