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Introduction: The principle of allocating budgets to primary care units by their QOF scores on issues according to metrics, it encourages them to improve the quality of their services and respond to major public health problems. The aimed of mixed-methods study was used to study a system for managing quality using key indexes of performance, and the results of a quality and outcome framework (QOF), factors affecting QOF, and the impact of QOF on primary care units and community health in the National Health Security Office of Region 8, Udon Thani, Thailand.
Methods: A mixed-methods approach including qualitative and quantitative aspects was used to study a system for managing quality using key indexes of performance, and the results of a quality and outcome framework (QOF), factors affecting QOF, and the impact of QOF on primary care units and community health in the National Health Security Office of Region 8, Udon Thani, Thailand. The data were collected in in-depth interviews, focus group discussions, and secondary data on the Thai population drawn from clinic and health services units over the last 3 years. The participants were 978 health officials in seven provinces and 38 key informants. All data were analyzed using descriptive statistics and content analyses to ensure quality data.
Results:The results showed that the QOF management system configuration incorporated four elements, namely, quality of contributions to health promotion and disease prevention; primary care quality and outcomes; quality and performance of corporate development, forwarding, and administration services; and quality and performance of services for health problems. The mean expense for local services and QOF allocation was 34.41 baht(US$ 1.12)/population UC (SD = 4.6). The area of Udon Thani province had the highest average, of 43.6 baht(US$ 1.45)/population UC, and Loei Province had the lowest, of 14.5 baht (US$ 0.5)/population UC. The most important actors for successful management of QOF were the IT team, the key performance indicator (KPI) project manager, and the executive committee as administrators at the district and provincial levels. QOF service packages resulted in better quality of life for the residents of the province and promoted their health. It was necessary to develop services in terms of structure, process, and result. In addition, policy awareness, the mechanisms of DHS policy, the service plan, and the function of the family care team predicted 85.2% of the achievement QOF goals, and with a prediction error of 2.603 (R2 =.852, p < 0.05).
Discussion and Conclusion: The dimensions most affected by public health services were 1) Quality and performance of health promotion and disease prevention, 2) Performance on quality criteria and primary care, and 4) Quality and performance of essential services to respond to local health problems and with local services. It was concluded that the QOF service suite appropriateness promotes better quality of life and improves healthcare delivery. Such services must be developed in Thai communities.