BACKGROUND The science of measuring and reporting on the performance of healthcare systems is rapidly evolving. In the past decade, across many jurisdictions, organisations tasked with monitoring progress towards reform targets have broadened their purview to take a more system-functioning approach. Their aim is to bring clarity to performance assessment, using relevant and robust concepts - and avoiding reductionist measures - to build a whole-of-system view of performance. Existing performance frameworks are not fully aligned with these developments. METHODS An eight stage process to develop a conceptual framework incorporated literature review, mapping, categorisation, integration, synthesis and validation of performance constructs that have been used by organisations and researchers in order to assess, reflect and report on healthcare performance. RESULTS A total of 19 performance frameworks were identified and included in the review. Existing frameworks mostly adopted either a logic model (inputs, outputs and outcomes), a functional, or a goal-achievement approach. The mapping process identified 110 performance terms and concepts. These were integrated, synthesised and resynthesised to produce a framework that features 12 derived constructs reflecting combinations of patients' needs and expectations; healthcare resources and structures; receipt and experience of healthcare services; healthcare processes, functions and context; and healthcare outcomes. The 12 constructs gauge performance in terms of coverage, accessibility, appropriateness, effectiveness, safety, productivity, efficiency, impact, sustainability, resilience, adaptability and equity. They reflect four performance perspectives (patient, population, delivery organisation and system). CONCLUSIONS Internationally, healthcare systems and researchers have used a variety of terms to categorise indicators of healthcare performance, however few frameworks are based on a theoretically-based conceptual underpinning. The proposed framework incorporates a manageable number of performance domains that together provide a comprehensive assessment, as well as conceptual and operational clarity and coherence that support multifaceted measurement systems for healthcare.

中文翻译：

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结合患者，临床和系统的观点来评估医疗保健的绩效：一个集成的度量框架。

背景技术测量和报告医疗保健系统的性能的科学正在迅速发展。在过去的十年中，在许多辖区中，负责监督改革目标进度的组织扩大了其职权范围，以采用更具系统功能的方法。他们的目的是使用相关且可靠的概念来使绩效评估更加清晰，并避免采用简化措施，以建立整个体系的绩效观。现有的绩效框架并未完全与这些发展保持一致。方法建立概念框架的八阶段过程包括文献回顾，映射，分类，集成，综合和验证绩效结构，这些结构已被组织和研究人员用来评估，反映并报告医疗保健绩效。结果总共确定了19个绩效框架并将其包括在审查中。现有框架大多采用逻辑模型（输入，输出和结果），功能或目标实现方法。映射过程确定了110个性能术语和概念。这些被整合，合成和重新合成以产生一个框架，该框架具有12种衍生结构，反映了患者的需求和期望的组合。医疗保健资源和结构；医疗服务的接收和经验；医疗过程，功能和背景；和医疗成果。这12个结构会根据覆盖范围，可访问性，适当性，有效性，安全性，生产力，效率，影响，可持续性，弹性，适应性和公平性。它们反映了四个绩效角度（患者，人群，分娩组织和系统）。结论在国际上，医疗保健系统和研究人员已使用各种术语对医疗保健绩效的指标进行分类，但是很少有基于理论基础的概念基础的框架。提议的框架包含了可管理数量的性能域，它们共同提供了全面的评估，以及概念和操作的清晰性和连贯性，为医疗保健的多方面测量系统提供了支持。但是，很少有框架基于理论上的概念基础。拟议的框架包含了可管理数量的性能域，它们共同提供了全面的评估，以及概念和操作的清晰度和连贯性，为医疗保健的多方面测量系统提供了支持。但是，很少有框架基于理论上的概念基础。拟议的框架包含了可管理数量的性能域，它们共同提供了全面的评估，以及概念和操作的清晰度和连贯性，为医疗保健的多方面测量系统提供了支持。