Developing and testing quality indicators for the Thai Quality and Outcomes Framework

Roongnapa KhampangEmail author View ORCID ID profile,
Yot Teerawattananon,
Sripen Tantivess,
Francoise Cluzeau,
Rachel Foskett-Tharby and
Paramjit Gill

Safety in Health20173:14

https://doi.org/10.1186/s40886-017-0065-6

Received: 11 September 2017

Accepted: 30 October 2017

Published: 13 November 2017

Abstract

Background

Primary care serves as an entry point in the Thai health care system. Whilst effective interventions are provided in the primary care setting, the quality of the services have not been measured or tracked. A number of initiatives were undertaken to improve primary health care quality including the use of financial incentives to reward adherence to performance indicators. However, there were concerns that the current quality indicators had not been developed in a systematic, participatory, and evidence-based manner. Therefore, this study aims to develop new quality indicators for use in subsequent iterations of the program.

Methods

The development of indicators follows a well-designed approach. Reviews of existing documents as well as secondary data analyses were performed and presented to key stakeholders. Disease areas were then prioritised. Recommendations from the Thai clinical practice guidelines on the prioritised areas were then used to formulate statements and templates for each indicator. Finally, the indicators developed were piloted for 3 months in 28 primary care units across the country.

Results

Indicators related to care for diabetes and hypertension, maternal and child health, and rational use of antibiotics received high acceptability, and information was available and collectable in the current administrative database. However, there were problems in implementing indicators for managing cardiovascular risk, care for bedridden patients, and asthma and COPD.

Conclusions

The development of quality indicators using a guideline-based approach is a useful way of generating evidence to support the effective implementation of a program. Indicator piloting is recommended prior to introducing indicators in the health system.