Mapping Quality Indicators in Primary Health Care: A Scoping Review of Contemporary Approaches and Persistent Measurement Gaps

Abstract

Background/Objectives: Quality indicators are essential for evaluating and improving primary health care (PHC), but existing indicator sets differ considerably in their definitions, development methods, data requirements, and applicability across healthcare systems. This scoping review aimed to identify and synthesize quality indicators used to assess PHC services, describe the principal areas and methodological approaches represented, and identify persistent measurement gaps. Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. PubMed/MEDLINE, Embase, and CINAHL were searched from inception to December 2025, with an updated search conducted on 27 August 2026. Targeted grey-literature searches of World Health Organization, United Nations Children’s Fund, and Organisation for Economic Co-operation and Development sources were also undertaken. Two reviewers independently screened the records and assessed potentially eligible full texts. Data were synthesized narratively and interpreted using the Donabedian structure–process–outcome framework, the seven World Health Organization dimensions of healthcare quality, and PHC-specific functions and content areas. Results: Twenty-three sources were included, comprising empirical studies, indicator-development and consensus studies, methodological reviews, national quality-improvement programmes, and international performance-measurement frameworks. Recurring areas included chronic disease management, preventive care, medication safety, access, continuity, service delivery, patient safety, efficiency, and healthcare utilization. Patient-reported outcomes and experiences, equity, social determinants of health, structural capacity, and broader outcomes meaningful to patients and populations were less consistently represented. Substantial heterogeneity in indicator definitions, reporting levels, data sources, and methodological approaches limited direct comparison across frameworks. Conclusions: PHC quality measurement remains extensive but fragmented. Future frameworks should balance structure, process, and outcome indicators, incorporate outcomes that matter to people, and combine standardized core measures with context-specific, feasible, valid, and actionable indicators.