Achieving consensus on indicators and measures of high quality in Australian general practice using a Delphi survey

Background: High quality primary health care (PHC) is key to containing spiralling health costs and providing equitable community-based care. Currently Australia is amongst OECD countries with the highest proportion of PHC funding as fee-for-service payments (90%), and there is no agreement on what constitutes high quality PHC to guide alternative funding models. In partnership with WentWest, the Western Sydney University 'Quality Equity and Systems Transformation in Primary Health Care (QUEST PHC)' team developed a suite of 79 indicators and their corresponding 128 measures of high quality general practice in 2019-2020. Aim/Objectives: To establish consensus with general practice and primary health networks (PHNs) on the relevance and feasibility of the QUEST PHC suite of indicators and measures for an Australian general practice context. Methods: Partnering with eight PHNs across four states, general practitioners, practice staff and PHN staff were recruited to participate in three rounds of an online Delphi survey to rate each indicator and measure on a Likert scale for relevance and feasibility. Participants were also asked to provide comments, suggestions and views regarding the implementation of a quality indicator tool. Agreement of ≥70% in both relevance and feasibility was required for each indicator and measure to reach consensus. Ratings were statistically analysed for response rates, level of agreement, means, standard deviations, medians, ranges and group rankings. Qualitative responses were thematically analysed. Results: Seventy-eight indicators and 127 measures achieved consensus. Thematic analysis indicated that although primary health care professionals feel that high-quality indicators and measures are relevant and feasible, they face numerous challengesin collecting these data including accessibility of appropriate assessment tools, patient compliance, time constraint and requirement of technological skills. Implications: Findings of the Delphi survey will contribute to the design of an assessment tool of high quality care in general practice that would enable future primary health care reforms in Australia.