Table 1.

Mapping of primary care indicators to Commission framework

	Descriptions specific to primary care
Competent systems
Safety	Primary care systems seek to prevent harm to patients by ensuring facility cleanliness and that safety precautions and other safety interventions (eg, sterilisation, sharp and waste disposal, infection-control items) are in place. An unsafe primary care system predisposes patients to adverse events and injuries due to medical devices and injuries due to surgical and anaesthesia errors, including wrong-site surgery, health-care-associated infections, improper transfusion and injection practices, falls, burns, and pressure ulcers.
Prevention and detection	The prevention and early detection of diseases, including through screening when indicated or referrals when needed, are important functions of high-quality health systems, especially primary care systems.
Continuity and integration	Continuity of care is shown by the health system's ability to retain people in care, and, for the patient, by their ability to see a clinician familiar with their medical history. Integration is the extent to which health services are delivered in a complementary and coherent manner. Scheduling of follow-up visits and tracking of care with vaccination cards and client records are some examples of ensuring continuous and integrated primary care systems.
Population-health management	Population-health management, such as outreach services and community meetings, is core to primary care systems, in which data for the patient population should be collected, analysed, and acted upon to optimise how to best manage specific diseases within that population.
Timely action	Timely actions in primary care systems optimise patient outcomes and reduce the need for additional admissions because of complications arising from service provision. Timeliness is also crucial for conditions that can be cured if treated early, including many cancers and conditions such as tuberculosis or diabetes, for which early treatment prevents transmission or disease progression. For people with life-threatening emergencies, such as labour complications, trauma, and strokes, treatment delays substantially increase mortality risk.
Evidence-based care
Technical quality indices for key primary care services*	Evidence-based care is exhibited when there is systematic assessment, correct diagnosis, appropriate treatment, and counselling. A systematic patient assessment involves gathering clinically relevant information by asking appropriate history questions and doing the recommended examinations and tests. Incorrect diagnoses have deleterious effects on health and contribute to treatment delays and antimicrobial resistance. Treatments should be appropriate: underuse of effective care and overuse of unnecessary care lead to primary care of poor quality. Proper counselling and client education are essential elements of evidence-based care. For example, during antenatal care, many skilled providers do not advise women about the signs of pregnancy complications or how to prevent HIV infection, and, when prescribing contraceptives, many do not discuss their potential side-effects.
Positive user experience
Patient focus	Providers have shown care that is respectful of, and responsive to, individual patient preferences, needs, and values.
Clear communication	Clear communication is shown when providers have adequately explained and discussed care plans and treatment processes such as follow-up visits and use of family-planning methods and their side-effects or other danger signs.

^*See appendix for specific indicators under evidence-based care for each type of service.