Quality of care can be measured in several dimensions: different clinical disciplines, structures/processes/outcomes of care (SPO), and also different domains of quality (effectiveness, safety, care coordination, patient-centeredness, efficiency, timeliness, and community/population health). To our knowledge, no previous study has compared different sets of performance measures in terms of how well they cover these different aspects of quality.

Compare the content coverage of major quality measure sets from Israel, the US, and the UK.

Review and categorization of performance measure sets, with disagreements between reviewers resolved through consensus.

We selected three sets of quality measures: HEDIS, the Healthcare Effectiveness Data and Information Set (USA), QOF, the Quality and Outcomes Framework (UK), and QICH, Quality Indicators for Community Healthcare (Israel). All measures were classified along three dimensions—clinical specialty, SPO, and seven domains of healthcare quality. We then compared the distribution of measures in each of the three sets, using Fischer’s exact tests and post hoc tests of pairwise differences.

In the medical specialty domain, all three countries focused primarily on family medicine/primary care. All three measure sets focused heavily on process measures, though to different extents, and all emphasized effectiveness of care, community/population health, and communication and care coordination over other domains of quality.

The measure sets we examined, which overwhelmingly measure processes of care, should be encouraged to add structure and outcomes measures. All three measure sets under-emphasize certain aspects of quality such as timeliness, care coordination, efficiency, and patient-centeredness. Finally, and most importantly, all three measure sets focused overwhelmingly on measuring the activities of family physicians; attention should be given to building measures that will examine the activities of other clinicians.