Challenges and opportunities with adapting international health care quality indicators to local contexts: A descriptive case study

BACKGROUND: International quality of care indicators provide a common framework for interoperability among different health care systems. We aimed to demonstrate the challenges and opportunities with adapting such quality indicators through the case of adapting the International Consortium for Health Outcomes Measurement (ICHOM) set of patient-centered outcome measures for older persons to the context of Canada. METHODS: In this descriptive case study, we purposefully recruited diverse stakeholders. Adapting a nominal group technique, we conducted group discussions to identify additional aspects deemed important for the context and needed to be added to the ICHOM. Transcripts were thematically analyzed to describe challenges and opportunities with adapting the ICHOM. RESULTS: Four older persons, seven clinicians, five health managers, and four decision-makers participated. Four emerging themes indicated that the ICHOM set for older persons was: 1) focusing on the negative aspects of care, suggesting an opportunity to have a positive perspective and strength-based approach; 2) omitting equity in care delivery, which should be across all domains; 3) disease-centered while a holistic approach was preferable; and 4) primarily descriptive although it is key to generating action plans. Ageing in place-helping older persons remain in the communities through integrated care-was viewed as the optimal outcome. CONCLUSION: International quality of care indicators are excellent starting points, but care must be taken to adapt them for use in local contexts. Social norms, relationships between users and health care providers, trust in health and social care systems, and contextual values are important factors to situate the quality indicators in an action-oriented context.