JMIR Publications

ABSTRACT

Background:

Quality indicators in primary care remain predominantly disease-specific and professionally defined, with limited incorporation of what matters most to people living with multiple long-term conditions (MLTC) and their caregivers. Existing frameworks and quality standards provide important conceptual direction, but few produce a pragmatic set of ready-to-use indicators.

Objective:

To co-develop a set of disease-agnostic quality-of-care indicators with people living and caring for those with MLTC that can pragmatically inform service improvement in primary care.

Methods:

This protocol describes a three-round modified RAND/UCLA Appropriateness Method (RAM) study. The first round will evaluate the importance of candidate indicators through an online questionnaire to patients, caregivers and expert healthcare professionals. Indicators without agreement or requiring revision will proceed to a structured consensus meeting (round 2) with subsequent rerating rounds (round 3) until consensus is reached.

Results:

This RAM study is currently underway, with planned completion in late 2026. Fifty-four candidate indicators have been generated through a scoping review of published quality indicator development studies and a qualitative interview study with 21 patients and caregivers living with MLTC. Ongoing patient and public involvement and engagement with four community partners has further informed the study design, interpretation of multi-stage findings, and refinement of candidate indicators. The indicators have been mapped to a structure-process-outcome quality framework and will be taken forward into a modified RAND/UCLA Appropriateness Method process.

Conclusions:

This study will generate a set of co-designed and implementation-oriented primary care quality indicators for MLTC. The final indicator set is intended to support future measurement, quality improvement, and later field testing in real-world primary care systems.