Developing Iranian primary health care quality Indicators and Dimensions

Abstract

Abstract: Objective: Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for universal health coverage. Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of primary health care in Iran's health system. Method and Material: A comprehensive review was conducted to identify PHC quality frameworks. The extracted quality dimensions and indicators after initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and indicators were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected indicators were categorized in form of the final dimensions of the quality of care. Results: Out of 698 quality indicators extracted from the existing body of literature, 55 items entered the Delphi process to be evaluated by the experts. Eventually, Iranian PHC quality framework was developed including 40 indicators were selected in the form of 7 dimensions of quality. Among these, 8 indicators of the dimension of access and equity, 5 indicators of safety dimension, 2 indicators of efficiency dimension, 13 indicators of effectiveness dimension, 2 indicators of patient-centeredness dimension, 3 indicators of governance dimension and 7 indicators of appropriateness dimension were presented. Conclusion: Iranian PHC quality framework could be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided. Keywords: Assessment Framework, Quality of Care, Quality Indicators, Primary Health Care