Table 2.

Health service performance trends over time.

Category	Performance trend	Definition	Group for logistic regression analysis
1	Consistent high improvement	Service showed consistent ascending performance scores in an audit from first to last audit and bridged a certain percentage of the gap between the first score and 100% depending on the number of audits it had completed, e.g., if a health service had completed four audits in the maternal audit, then it was required to bridge 30% of the gap (between its first audit performance score and 100%) to be classified as a consistent high improver in maternal health	Positive
2	Sustained high performance	Service demonstrated performance score of its last audits in the top tertile (67th percentile or higher) for a particular audit, e.g., for the Type 2 diabetes audit, the top tertile was a performance score of 73 or higher. For a PHC service that had completed six audits, if the last four performance scores were 73 or higher, it was classified as a sustained high performer	Positive
3	Decline	Service showed consistent descending performance scores from first to last audit and bridged a certain percentage of the gap between the first audit score and 0% depending on the number of audits it had completed, e.g., if a health service had completed four audits, then it was required to bridge 30% of the gap between its first audit performance score and 0% to be classified as a decliner	Negative
4	Marked variability	A PHC service was classified as having a marked variability if the difference between its maximum and minimum performance score was >33% (or a tertile) of its median score, and it showed opposite trends of at least 10% in the preceding and following three audits	Negative
5	Consistent low performance	Services that consistently performed below the baseline median performance of the audit tool	Negative
6	No clear increase or decrease over time (no specific trend)	A PHC service was classified as having no specific increase or decrease over time if its performance score was less than the top tertile in the first audit and not more than a 33% difference (or a tertile) between maximum and minimum, or if the PHC service does not fall under any of the above categories	Neutral