Towards a harmonised framework for developing quality of care indicators for global health: a scoping review of existing conceptual and methodological practices.

Objectives: Despite significant advances in the science of quality of care measurement over the last decade, approaches to developing quality of care indicators for global health priorities are not clearly defined. We conducted a scoping review of concepts and methods used to develop quality of healthcare indicators to better inform ongoing efforts towards a more harmonised approach to quality of care indicator development in global health.

Methods: We conducted a systematic search of electronic databases, grey literature and references for articles on developing quality of care indicators for routine monitoring in all healthcare settings and populations, published in English between 2010 and 2020. We used well-established methods for article screening and selection, data extraction and management. Results were summarised using a descriptive analysis and a narrative synthesis.

Results: The 221 selected articles were largely from high-income settings (89%), particularly the USA (46%), Canada (9%), UK (9%) and Europe (17%). Quality of care indicators were developed mainly for healthcare providers (56%), for benchmarking or quality assurance (37%) and quality improvement (29%), in hospitals (32%) and primary care (26%), across many diseases. The terms 'quality indicator' and 'quality measure' were the most frequently encountered terms (50% and 21%, respectively). Systematic approaches for quality of care indicator development emerged within national quality of care systems or through cross-country collaborations in high-income settings. Maternal, neonatal and child health (33%), mental health (26%) and primary care (57%) studies applied most components of systematic approaches, but not consistently or rigorously.

Discussion: The current evidence shows variations in concepts and approaches to developing quality of care indicators, with development and application mainly in high-income countries.

Conclusion: Additional efforts are needed to propose 'best-practice' conceptual frameworks and methods for developing quality of care indicators to improve their utility in global health measurement.