Developing an integrated evaluation indicator system for non-communicable disease management in China’s primary care: a modified Delphi-analytic hierarchy process study based on the structure-process-outcome framework

Background: 

The aging population and increasing prevalence of chronic conditions have led to higher healthcare costs and greater resource utilization globally, exerting considerable pressure on healthcare system sustainability. Integrating services in primary healthcare can improve access and effectiveness for chronic disease management. However, China’s primary healthcare institutions have not achieved full integration of essential clinical services and public health services, hindering the continuity of care and chronic disease management. Guided by the Structure- Process- Outcome framework, this study aimed to develop core indicators to evaluate the capacity of integrated noncommunicable disease services within China’s public healthcare system. 

Methods: 

A modified Delphi method was employed with 22 experts over two rounds between January and May 2025. The panel reached a consensus on key indicators for integrating clinical and preventive services in primary healthcare institutions. The Analytic Hierarchy Process was employed to determine the weight values of the indicators. 

Results: 

A total of 78 indicators were identified, comprising 34 structural, 15 process, and 29 outcome indicators, with weight values of 0.2807, 0.2708, and 0.4485, respectively. The authority coefficient (Cr) was 0.7795. The coordination of experts’ opinions, measured by the Kendall coordination coefficient W, ranged from 0.219 to 0.246 (P < 0.01). Additionally, the consistency ratio (CR) values for each level were < 0.1. 

Conclusions: 

This study established a core set of indicators to evaluate the integration of clinical care and preventive services within China’s primary healthcare institutions. These indicators reflect the global health priorities of people-centered and inter-sectorally coordinated care. They support policy implementation and offer valuable insights for other countries seeking to develop or strengthen integrated primary healthcare systems in response to the growing chronic disease burden.