Primary health care quality indicators: An umbrella review

Nowadays, evaluating the quality of health services, especially in primary health care (PHC), is increasingly important. In a historical perspective, the Department of Health (United Kingdom) developed and proposed a range of indicators in 1998, and lately several health, social and political organizations have defined and implemented different sets of PHC quality indicators. Some systematic reviews in PHC quality indicators are reported but only in specific contexts and conditions. The aim of this study is to characterize and provide a list of indicators discussed in the literature to support managers and clinicians in decision-making processes, through an umbrella review on PHC quality indicators. The methodology was performed according to PRISMA Statement. Indicators from 33 eligible systematic reviews were categorized according to the dimensions of care, function, type of care, domains and condition contexts. Of a total of 727 indicators or groups of indicators, 74.5% (n = 542) were classified in process category and 89.5% (n = 537) with chronic type of care (n = 428; 58.8%) and effective domain (n = 423; 58.1%) with the most frequent values in categorizations by dimensions. The results of this overview of reviews are valuable and imply the need for future research and practice regarding primary health care quality indicators in the most varied conditions and contexts to generate new discussions about their use, comparison and implementation.当前，医疗服务质量评估的重要性日益凸显，其中基层医疗（Primary Health Care, PHC）领域的评估尤为关键。从历史视角来看，英国卫生部（Department of Health, United Kingdom）于1998年制定并提出了一系列评估指标；近年来，多家健康、社会及政治组织也相继定义并推行了多套不同的基层医疗质量评估指标。目前虽已有部分关于基层医疗质量评估指标的系统综述发表，但此类研究仅局限于特定场景与条件。本研究旨在通过针对基层医疗质量评估指标的伞状综述（Umbrella Review），梳理并汇总文献中提及的各类评估指标清单，为管理者与临床医师的决策提供支撑。本研究的方法学严格遵循PRISMA声明执行。研究人员从33篇符合纳入标准的系统综述中提取评估指标，并按照照护维度、功能维度、照护类型、研究领域及场景条件进行分类。在总计727项指标或指标组中，74.5%（n=542）被归类为过程类指标；而在各维度分类中，占比最高的两类分别为慢性疾病照护类型（n=428，58.8%）与有效照护领域（n=423，58.1%），对应总样本的89.5%（n=537）。本伞状综述的研究结果具有重要参考价值，同时也提示，未来需针对多样化场景与条件下的基层医疗质量评估指标开展更多研究与实践，以推动关于其应用、对比与落地的新探讨。