Refinement of indicators and criteria in a quality tool for assessing quality in primary care in Canada: a Delphi panel study.
OBJECTIVE
Primary care is the cornerstone of the health care system and increasingly countries are developing indicators for assessing quality in primary care practices. The 'Quality Tool', developed in Ontario, Canada, provides a framework for assessing practices and consists of indicators and criteria. The purpose of this study was to validate the indicators and simplify the Quality Tool.


METHODS
This study involved a systematic comparison of indicators in the Quality Tool with those in other local and international tools to determine common indicators to include as valid in the Quality Tool. A Delphi process was used to help reach consensus for inclusion of any indicators that were not included in the comparison exercise.


METHODS
Primary care in Ontario, Canada.


METHODS
Key informants were those with known expertise and experience in quality assessment in primary care.


RESULTS
Validated set of indicators for inclusion in an updated Quality Tool.


RESULTS
Twenty-three stakeholders participated in the Delphi panel. Forty-four indicators were included as valid after the systematic comparison of similar indicators in other assessment tools. Of the 63 indicators brought to the Delphi panel, 37 were included as valid, 15 were excluded and 11 became criteria for other included indicators.


CONCLUSIONS
The study resulted in a set of 81 validated primary care indicators. The validation of the indicators provided a strong foundation for the next version of the Quality Tool and may be used for quality assessment in primary care.
Department of Family Medicine, McMaster University, Hamilton, Canada. clevitt@mcmaster.ca.
Cheryl A
CA
Levitt
Department of Family Medicine, McMaster University, Hamilton, Canada.
Kalpana
K
Nair
Department of Family Medicine, McMaster University, Hamilton, Canada.
Lisa
L
Dolovich
Department of Family Medicine, McMaster University, Hamilton, Canada.
David
D
Price
Department of Family Medicine, McMaster University, Hamilton, Canada.
Linda
L
Hilts
D003697:Delphi Technique; D006801:Humans; D009864:Ontario; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care
Delphi technique; family practice; general practice; primary health care; quality improvement; quality indicators.