Abstract
Background
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.
Objective
Compare the content coverage of major quality measure sets from Israel, the US, and the UK.
Design
Review and categorization of performance measure sets, with disagreements between reviewers resolved through consensus.
Main Measures
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.
Key Results
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.
Conclusions
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.
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Data Availability
The content of QICH, QOF, and HEDIS measures are all available online. Anyone who has difficulty understanding QICH measure specifications in Hebrew is invited to contact the authors for help.
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Acknowledgements
The authors wish to thank Professor Ronit Calderon, the Director of the QICH program, for encouraging us to undertake this analysis.
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Contributions
Study conception: AJR.
Design of review process: RI, AJR.
Review of quality measures, consensus discussions: All authors.
Statistical analysis: RI.
Drafting of manuscript: RI.
Revision of manuscript for important content: All Authors.
Approval of final version: All authors.
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Israeli, R., Geva, G.A. & Rose, A.J. Evaluating and Comparing the Content Coverage of Quality Measure Sets from Israel, the United States, and the United Kingdom. J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-09363-3
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DOI: https://doi.org/10.1007/s11606-025-09363-3