Abstract
Background
Policymakers worldwide are prioritising primary care reforms to enhance health system resilience, sustainability, and performance in response to increasing complexity and demands. Quality Improvement (QI) and its associated quality indicators will be key to these reforms, enabling measurement and feedback to be embedded in routine care.
Aim/Objective
This review aimed to examine how quality, safety, or performance indicators are implemented in primary care, and to analyse the factors that influence their use.
Methods
Empirical investigations of the implementation of quality, safety, and performance indicators in primary care, published in Medline, EMBASE, and Scopus, were included in this review. Data from included studies were thematically analysed in two ways: (1) implementation strategies were deductively mapped to the People, Process, Technology (PPT) framework, and (2) barriers and facilitators were inductively analysed.
Findings
Twenty-three studies were included, conducted in diverse primary care settings, focused on a range of improvement approaches. They predominantly used mixed or qualitative methods. Indicator implementation frequently leveraged electronic health record data (18/78.3%) and digital tools for automated data extraction (n=15/65.2%), analysis (n=13/56.5%), and feedback (16/69.6%). Commonly reported feedback strategies included performance benchmarking (8/34.8%), audit and feedback (n=16/69.6%), and cohort risk identification with clinical decision support (n=17/73.9%). Specific to barriers and facilitators, six key themes emerged: alignment with value at all levels, incentivisation for participation and outcomes, collaborative leadership and culture, practice infrastructure and capacity, self-generating clinical improvement cycles, and digital enablement.
Implications
Multiple sets of interrelated factors drive the successful use of quality, safety and performance indicators in primary care settings. Given the increasing reliance on digital technologies to enhance data capture and feedback, the PPT framework may offer a particularly useful lens through which to view, navigate and enhance implementation efforts. These findings may be used to guide the resourcing and selection of implementation strategies for data-driven learning and improvement in primary care.
Policymakers worldwide are prioritising primary care reforms to enhance health system resilience, sustainability, and performance in response to increasing complexity and demands. Quality Improvement (QI) and its associated quality indicators will be key to these reforms, enabling measurement and feedback to be embedded in routine care.
Aim/Objective
This review aimed to examine how quality, safety, or performance indicators are implemented in primary care, and to analyse the factors that influence their use.
Methods
Empirical investigations of the implementation of quality, safety, and performance indicators in primary care, published in Medline, EMBASE, and Scopus, were included in this review. Data from included studies were thematically analysed in two ways: (1) implementation strategies were deductively mapped to the People, Process, Technology (PPT) framework, and (2) barriers and facilitators were inductively analysed.
Findings
Twenty-three studies were included, conducted in diverse primary care settings, focused on a range of improvement approaches. They predominantly used mixed or qualitative methods. Indicator implementation frequently leveraged electronic health record data (18/78.3%) and digital tools for automated data extraction (n=15/65.2%), analysis (n=13/56.5%), and feedback (16/69.6%). Commonly reported feedback strategies included performance benchmarking (8/34.8%), audit and feedback (n=16/69.6%), and cohort risk identification with clinical decision support (n=17/73.9%). Specific to barriers and facilitators, six key themes emerged: alignment with value at all levels, incentivisation for participation and outcomes, collaborative leadership and culture, practice infrastructure and capacity, self-generating clinical improvement cycles, and digital enablement.
Implications
Multiple sets of interrelated factors drive the successful use of quality, safety and performance indicators in primary care settings. Given the increasing reliance on digital technologies to enhance data capture and feedback, the PPT framework may offer a particularly useful lens through which to view, navigate and enhance implementation efforts. These findings may be used to guide the resourcing and selection of implementation strategies for data-driven learning and improvement in primary care.
| Original language | English |
|---|---|
| Number of pages | 1 |
| Publication status | Published - 11 Aug 2025 |
| Event | Australasian Association for Academic Primary Care Annual Research Conference - Deakin University, Geelong, Australia Duration: 11 Aug 2025 → 12 Aug 2025 |
Conference
| Conference | Australasian Association for Academic Primary Care Annual Research Conference |
|---|---|
| Country/Territory | Australia |
| City | Geelong |
| Period | 11/08/25 → 12/08/25 |
Keywords
- Quality Improvement
- Learning health systems
- Primary Care
- Data-driven decision making (DDDM)