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Table 2 Quality Evaluation QIs in Iran’s Primary Health Care

From: Developing Iranian primary health care quality framework: a national study

Domains Level Indicators Relevance Importance Feasibility Total references
Access and equity Structure 1. % of catchment population who received at least one basic visit 84.71 87.06 80.59 84.12 [28]
Process 2. % of patients with mental disorders that have had a follow-up visit in defined period according to national protocol. 80.54 82.16 68.65 77.12 [29]
Outcome 3. % of pregnant women with first visit at the first trimester 94.74 92.63 91.58 92.98 [20]
4. % of population, age 30 to 59 years old with overweight and obesity who received consultation services for behavioral change 90.00 89.47 69.47 82.98 [22]
5. % of smokers, age 18 and older who receive smoking cessation consultation 89.71 88.57 62.29 80.19 [30, 31]
6. % of student age 6 to 14 years old who received florid therapy 90.27 89.19 88.65 89.37 expert panel
7. Clinical staff provide home visits for patients who are physically not able to travel to the practice 76.84 77.37 56.84 70.35 [32]
8. % of individuals with COPD that have had a follow-up visit and treatment during the last year. 79.46 79.46 63.24 74.05 [14]
9. Individual self-care program coverage Final Expert Panel
safety Process 10. % of health facility staff immunized for Hepatitis B (3 doses). 84.74 77.89 89.47 84.04 [33]
11. % of safe injections in the health care facility 81.05 82.63 73.16 78.95 [34, 35]
12. % of Staff who have attended continuous training about quality and patient safety during last year 77.78 78.89 79.44 78.70 [36, 37]
13. % compliance with Hand Hygiene guidelines 81.03 77.95 73.33 77.44 [38, 39]
Outcome 14. Number of adverse events reported (immunization/medication) 87.18 88.21 80.51 85.30 [40, 41]
Efficiency Process 15. % of prescriptions that include antibiotics in health centers and health posts 77.89 78.42 69.47 75.26 [42]
Outcome 16. % of the 13 essential non communicable diseases medicines with no stock out in last 3 months (cardiovascular, diabetes, hypertension and COPD) 82.29 80.57 73.14 78.67 [43]
Effectiveness Outcome 17. % Hypertension patients with Initial laboratory investigations 80.00 81.05 67.37 76.14 [44,45,46]
18. % of registered hypertension patients with BP < 140/90 at last 2 follow up visits 91.28 90.26 78.46 86.67 [47]
19. % of registered diabetic patients with fasting blood sugar controlled at last 2 follow up visits 94.36 94.36 81.03 89.91 [48, 49]
20. % of registered NCD patients age 30 and older with 10 years’ cardiovascular risk recorded in past 1 year 95.90 92.82 78.97 89.23 [43, 50]
21. % of registered NCD patients with blood pressure recorded twice at last follow up visit 93.33 93.33 83.08 89.91 [43, 51]
22. % children age 6 to 9 months old screened for anemia 85.64 86.67 71.28 81.20 [52, 53]
23. % of women who delivered and received at least once postnatal care within the first 6 weeks 92.31 90.77 82.05 88.38 [54]
24. % of under 23 months children immunized according to the national protocol 96.92 97.44 95.90 96.75 [55]
25. % of people that work in the workshop of under 20 labor worker and whose were basic visit and occupational care in past years. Final expert panel
26. % of diabetic people with HbA1C less than 7% 92.82 90.77 75.90 86.50 [56, 57]
27. % of pregnant women received at least 6 ANC 89.73 86.49 80.54 85.59 [58]
28. % of under 5 children that had weight and height measured in past 1 year 96.41 93.33 92.82 94.19 [59]
29. % of newborns who are exclusively breastfed for the first six months 93.85 93.33 85.64 90.94 [54]
Patient centeredness Outcome 30. % of patients aware about Patients’ rights and responsibilities 77.30 75.68 58.92 70.63 [60, 61]
31. Customer satisfaction rate (%) 82.22 87.22 63.89 77.78 [62]
governance Outcome[55] 32. Staff satisfaction rate 84.24 86.06 69.09 79.80 [63]
33. % of appropriate (upward) referrals during last 6 months (by specific conditions) with appropriate feedback 82.70 82.16 62.16 75.68 [64, 65]
appropriateness Process 34. % of population, age 30 and older, with diabetes mellitus who received following exams:
 • Hemoglobin A1c (Hba1c);
 • Eye examination;
 • Foot Examination;
 • Blood Pressure Measurement
92.97 93.51 71.89 86.13 [66]
35. % of population, age 20 and older, with depression who received following exams:
 • PHQ
 • Active follow up
 • non-communicable diseases risk factors assessment
 • Drug Side effects assessment
83.68 87.37 62.11 77.72 expert panel
36. % of pregnant women who received health education about:
 • nutritional care
 • anemia
 • sanitation
 • high risk pregnancy signs
94.87 93.85 84.10 90.94 [67,68,69]
Outcome 37. % TB screening in high risk groups 95.14 92.43 83.78 90.45 expert panel
38. % of women aged 30–59 yrs. who had at least 1 Pap test in the past 5 yrs. 87.37 86.32 82.11 85.26 [14]
39. % of risk factors Assessment for AIDS in The population covered. 92.97 93.51 70.27 85.59 expert panel
40. % of water microbial sampling According to standard. 93.51 90.81 90.27 91.53 expert panel