Assessing the acceptability of quality indicators and linkages to payment in primary care in Nova Scotia

In 2006, the Canadian Institute for Health Information (CIHI) released a comprehensive set of quality indicators (QIs) for primary healthcare (PHC). We explored the acceptability of a subset of these as measures of the technical quality of care and the potential link to payment incentive tools. A modified Delphi approach, based on the RAND consensus panel method, was used with an expert panel composed of PHC providers (family physicians, nurses and nurse practitioners) and decision-makers with no previous experience of "pay for performance." A nine-point Likert scale was used to rate the acceptability of 35 selected CIHI QIs in community practice and the acceptability of a payment mechanism associated with each. QIs rated with disagreement were discussed and re-rated in a face-to-face meeting. The panel rated 19 QIs as "acceptable." Payment incentives associated with these QIs were acceptable for 13. Several factors emerged that were common to the less appealing QIs with respect to payment linkage.