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Key elements of high-quality practice organisation in primary health care: a systematic review

There has been a growing international evolution of the role and purpose of quality improvement in primary care; particularly in the United Kingdom, Europe, Australia and New Zealand. Research has focused on improving clinical care programs, with a corresponding focus on the identification and development of clinical measures and indicators of quality care. Subsequently, attention has been given to the role of clinical governance in the delivery of high-quality care in general practice, and exploration of the relationship between clinical management and patient health outcomes.15

The past 12 years also witnessed an international movement from funders paying for activity to paying for outcomes. The UK introduced “pay for performance” in 2002, resulting in general practices receiving up to 25% of their funding from measuring and reporting against 134 quality benchmarks.6 The United States debated options including significant bundled payments to family practitioners for quality targets.7 New Zealand developed a framework to guide clinical quality in primary care.8 Australia’s quality measures, including the Practice Incentives Program and Service Incentive Payments, were introduced in 2002, but their funding has been progressively decreased over recent…

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