EXPH (EXpert Panel on effective ways of investing in Health). Opinion on Tools and Methodologies for Assessing the Performance of Primary Care.

The report "Tools and methodologies for assessing the performance of primary care” starts with a definition of the role and goals of primary care, based on previous opinions by the EXPH. From the primary care definition formulated in 2014, 8 domains and dimensions of primary care can be defined. Additionally, the domains of primary care organisation and human resources are added, so that 10 dimensions are eventually identified. This opinion uses the adapted framework of structure, process and outcome as developed by Donabedian. Starting from the question "How is primary care structured?", a performance assessment system for primary care is defined, focusing on how access to primary care services occurs, how providers of primary care are organised, and how resources are managed in the system. With regards to the processes through which primary care is delivered, coordination of care and integration are described. When it comes to "outcomes" of primary care, the opinion examines relevance, equity, quality and financial sustainability. The need for using professional, contextual and policy evidence, when describing quality of care is emphasized. All these dimensions are translated into indicators: presenting on the one hand, a set of comparative key-indicators, and on the other hand, descriptive additional indicators. The EXPH proposes examples of comparative key-indicators related to the 10 domains of primary care that are identified. The procedural steps that are required for a performance assessment system are explored including: multi-dimensionality, shared design, evidence-based, benchmarking of results, timeliness and transparent disclosure. To ensure the selection of a set of indicators that are relevant to each health system, three criteria are proposed; alignment of indicators with objectives of the health system, ability to routinely collect the indicator, the validity and reliability of information. As a reality check, recent experiences from European countries, as documented by the EU Expert Group on Health Systems Performance Assessment, are considered. Actual problems and bottle necks in performance assessment in primary care are debated in the discussion, paying special attention to the importance of context when outcomes are reported. Finally, the report formulates recommendations for further development of the framework in the European Union.