abstract: 'Background: Quality measurements in primary healthcare (PHC) have become

  an essential component for improving diabetes outcomes in many

  high-income countries. However, little is known about their

  implementation within the Chinese health-system context and how they are

  perceived by patients, physicians, and policy-makers. We examined

  stakeholders??? perceptions of quality and performance measurements for

  primary diabetes care in Shanghai, China, and analyzed facilitators and

  barriers to implementation. Methods: In-depth interviews with 26 key

  stakeholders were conducted from 2018 to 2019. Participants were sampled

  from two hospitals, four community healthcare centers (CHCs), and four

  institutes involved in regulating CHCs. The Consolidated Framework for

  Implementation Research (CFIR) guided data analysis. Results: Existing

  quality measurements were uniformly implemented via a top-down process,

  with daily monitoring of family doctors??? work and pay-for-performance

  incentives. Barriers included excluding frontline clinicians from

  indicator planning, a lack of transparent reporting, and a rigid

  organizational culture with limited bottom-up feedback. Findings under

  the CFIR construct ???organizational incentives??? suggested that

  current pay-for-performance incentives function as a ???double-edged

  sword,??? increasing family doctors??? motivation to excel while

  creating pressures to ???game the system??? among some physicians. When

  considering the CFIR construct ???reflecting and evaluating,???

  policy-makers perceived the online evaluation application ??? which

  provides daily reports on family doctors??? work ??? to be an essential

  tool for improving quality; however, this information was not visible to

  patients. Findings included under the ???network and communication???

  construct showed that specialists support the work of family doctors by

  providing training and patient consultations in CHCs. Conclusion: The

  quality of healthcare could be considerably enhanced by involving

  patients and physicians in decisions on quality measurement.

  Strengthening hospital???community partnerships can improve the quality

  of primary care in hospital-centric systems. The case of Shanghai

  provides compelling policy lessons for other health systems faced with

  the challenge of improving PHC.'
affiliation: 'Rasooly, A (Corresponding Author), Ben Gurion Univ Negev, Sch Publ Hlth,
  Beer Sheva, Israel.

  Rasooly, Alon; Ellen, Moriah E.; Davidovitch, Nadav, Ben Gurion Univ Negev, Sch
  Publ Hlth, Beer Sheva, Israel.

  Pan, Yancen, Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Epidemiol, Los
  Angeles, CA USA.

  Tang, Zhenqing; Jiangjiang, He, Shanghai Hlth Dev Res Ctr, Shanghai, Peoples R China.

  Manor, Orly, Hebrew Univ Jerusalem, Braun Sch Publ Hlth \& Community Med, Jerusalem,
  Israel.

  Hu, Shanlian, Fudan Univ, Sch Publ Hlth, Shanghai, Peoples R China.'
author: Rasooly, Alon and Pan, Yancen and Tang, Zhenqing and Jiangjiang, He and Ellen,
  Moriah E. and Manor, Orly and Hu, Shanlian and Davidovitch, Nadav
author-email: rasooly@post.bgu.ac.il
author_list:
- family: Rasooly
  given: Alon
- family: Pan
  given: Yancen
- family: Tang
  given: Zhenqing
- family: Jiangjiang
  given: He
- family: Ellen
  given: Moriah E.
- family: Manor
  given: Orly
- family: Hu
  given: Shanlian
- family: Davidovitch
  given: Nadav
da: '2023-09-28'
doi: 10.34172/ijhpm.2022.6372
earlyaccessdate: JUN 2022
eissn: 2322-5939
files: []
journal: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
keywords: 'Quality Indicators; Primary Health Care; Diabetes Mellitus; China; CFIR;

  Implementation Science'
keywords-plus: 'PRIMARY-HEALTH-CARE; RISK-FACTORS; PAY; PROGRAM; DISPARITIES; OUTCOMES;

  TAIWAN; REFORM; IMPACT'
language: English
month: 2022 JUN 7
number-of-cited-references: '72'
orcid-numbers: 'Davidovitch, Nadav/0000-0001-5709-9265

  Ellen, Moriah/0000-0001-7127-7283

  Rasooly, Alon/0000-0002-0388-9883'
papis_id: 6758e67372b5f43a626f8fdc34be8520
ref: Rasooly2022qualityperformance
times-cited: '0'
title: 'Quality and Performance Measurement in Primary Diabetes Care: A Qualitative
  Study in Urban China'
type: article
unique-id: WOS:000810407900001
usage-count-last-180-days: '12'
usage-count-since-2013: '24'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2022'