Introduction

This chapter explores the value and complexities of measuring performance in primary care. We begin with a definition of primary care and a description of its importance within the wider health-care system. We then explore the importance of measuring performance in this setting and provide an overview of some of the quality improvement strategies currently in use. The second part of the chapter describes a conceptual framework for quality measurement and reporting; the qualities of an ideal performance measure; and the relative value of process and outcome measures within primary care. The third part describes three very different primary-care focused systems in which performance measurement has been critical to improving health care: (i) Quality and Outcomes Framework in the United Kingdom; (ii) changes in the Veterans Health Administration in the United States; and (iii) European Practice Assessment. We conclude by highlighting challenges that policy-makers, researchers and clinicians face in future performance measurement in primary care.

Background to performance measurement in primary care

Defining primary care

WHO made the improvement of primary health care a core policy in the Alma-Ata declaration (WHO 1978) and the Health for All by the Year 2000 strategy. The World Health Assembly renewed the commitment to global improvement in health (particularly for the most disadvantaged populations) in 1998 and this led to the Health for All in the 21st Century policy and programme.