Selection of primary health care quality indicators in Europe: A Delphi study protocol.

Objective: To describe a protocol to achieve consensus on valid and important indicators to assess primary health care (PHC) quality regarding all clinical contexts of PHC in European health systems.

Study Design: Qualitative study using the Delphi technique to gain consensus among European panels of experts comprising a heterogeneous professional background.

Methods: Potential candidate indicators were extracted and translated according to a set of informative elements (i.e., name, description, formula, unit of analysis, and sources). This list was then independently reviewed, and duplicates were removed totaling 1726 indicators. To guarantee a good response rate, indicators were distributed across 57 Delphi panels organized by clinical context. Each panel is a Delphi process, assessing between 23 to 33 indicators. Experts' opinions on the validity and importance of the extracted indicators will be obtained through two rounds of online questionnaires, using a 9-point Likert scale and free-text boxes. To prevent biased responses, participation will be anonymous to other participants and to the team administrating panels. Consensus will be considered if at least 70% of ratings (≥7 assuming 10 participants) lie within the 7-9 range and less than 15% of ratings (<2 assuming 10 participants) are in the 1-3 range. Analysis of results will be streamlined and generalizable across panels using scripts.

Conclusions: This protocol will contribute to improve the quality of PHC in Europe by achieving a consensual and concise list of PHC quality indicators retrieved from the scientific literature that fit current clinical guidelines and populations' needs in countries from the European region according to the World Health Organization.