Fadlallah Racha, Bou-Karroum Lama, El-Jardali Fadi, Hishi Lama, Al-Akkawi Alaa, Tsolakian Ibrahim George, Hemadi Nour, Hamadeh Randa S, AbuAlRub Raeda, Hamadeh Randah R, Arfa Chokri
Health Management and Policy Department, American University of Beirut, Beirut, Lebanon.
Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
BMJ Glob Health. 2019 Aug 16;4(Suppl 8):e001477. doi: 10.1136/bmjgh-2019-001477. eCollection 2019.
Strong primary health care (PHC) leads to better health outcomes, improves health equity and accelerates progress towards universal health coverage (UHC). The Astana Declaration on PHC emphasised the importance of quality care to achieve UHC. A comprehensive understanding of the quality paradigm of PHC is critical, yet it remains elusive in countries of the Eastern Mediterranean Region (EMR). This study used a multistep approach to generate a policy-relevant research agenda for strengthening quality, safety and performance management in PHC in the EMR.
A multistep approach was adopted, encompassing the following steps: scoping review and generation of evidence and gap maps, validation and ranking exercises, and development of an approach for research implementation. We followed Joanna Briggs Institute guidelines for conducting scoping reviews and a method review of the literature to build the evidence and gap maps. For the validation and ranking exercises, we purposively sampled 55 high-level policy-makers and stakeholders from selected EMR countries. We used explicit multicriteria for ranking the research questions emerging from the gap maps. The approach for research implementation was adapted from the literature and subsequently tailored to address the top ranked research question.
The evidence and gap maps revealed limited production of research evidence in the area of quality, safety and performance management in PHC by country and by topic. The priority setting exercises generated a ranked list of 34 policy-relevant research questions addressing quality, safety and performance management in PHC in the EMR. The proposed research implementation plan involves collaborative knowledge generation with policy-makers along with knowledge translation and impact assessment.
Study findings can help inform and direct future plans to generate, disseminate and use research evidence to enhance quality, safety and performance management in PHC in EMR and beyond. Study methodology can help bridge the gap between research and policy-making.
强大的初级卫生保健（PHC）可带来更好的健康结果，改善健康公平性，并加速实现全民健康覆盖（UHC）的进程。《阿拉木图初级卫生保健宣言》强调了优质护理对实现全民健康覆盖的重要性。全面理解初级卫生保健的质量范式至关重要，但在东地中海区域（EMR）各国，这一范式仍难以捉摸。本研究采用多步骤方法，制定了一项与政策相关的研究议程，以加强东地中海区域初级卫生保健中的质量、安全和绩效管理。
采用了多步骤方法，包括以下步骤：范围界定审查以及证据和差距图的生成、验证和排序练习，以及研究实施方法的制定。我们遵循乔安娜·布里格斯研究所进行范围界定审查的指南和文献方法审查，以构建证据和差距图。对于验证和排序练习，我们有目的地从选定的东地中海区域国家抽取了55名高级政策制定者和利益相关者作为样本。我们使用明确的多标准对差距图中出现的研究问题进行排序。研究实施方法是根据文献改编的，随后进行了调整，以解决排名最高的研究问题。
证据和差距图显示，按国家和主题划分，初级卫生保健质量、安全和绩效管理领域的研究证据产出有限。优先事项确定练习生成了一份排名清单，列出了34个与政策相关的研究问题，涉及东地中海区域初级卫生保健中的质量、安全和绩效管理。拟议的研究实施计划涉及与政策制定者合作生成知识，以及知识转化和影响评估。
研究结果有助于为未来计划提供信息并指导其方向，以生成、传播和使用研究证据，从而加强东地中海区域及其他地区初级卫生保健中的质量、安全和绩效管理。研究方法有助于弥合研究与政策制定之间的差距。
