Quality of care for chronic conditions: Identifying specificities of quality aims based on scoping review and Delphi survey

ABSTRACT Background There is a need to implement good quality chronic care to address the ballooning burden of chronic conditions affecting all countries globally. However, to our knowledge, no systematic attempts have yet been made to define and specify aims for chronic care quality. Objective We conducted a scoping review and Delphi survey to establish and validate a comprehensive specification of chronic care quality aims. Methodology The Institute of Medicine’s (IOM) quality of care definition and aims was utilised as our base. We purposively selected scientific and grey literature that have acknowledged and unpacked the plurality of quality in chronic care and which proposed/made use of frameworks and studied their implementation or investigated minimum two IOM care quality aims and their implementation. We critically analysed the literature deductively and inductively. We validated our findings through Delphi survey involving international chronic care experts, mostly coming from/have expertise on low-and-middle-income countries. Results We considered the natural history of chronic conditions and the journey of a person with chronic condition to define and identify aims of chronic care quality. We noted that the six IOM aims apply but with additional meanings. We identified a seventh aim, continuity, which relates well to the issue of chronicity. Our panellists agreed with the specifications. Several provided contextualised interpretations and concrete examples. Conclusions Chronic conditions pose specific challenges underscoring the relevance of tailoring quality of care aims. Operationalization of this tailored definition and specified aims to improve, measure and assure quality of chronic care can be next steps.