OBJECTIVES: Delivery of high quality care has been associated with improved health outcomes and institutional performance. The objective of this study was to investigate the quality and performance indicators (QPIs) of providers of ambulatory health services of self-funded health plans.

METHODS: Two rounds of Delphi surveys were conducted using an online questionnaire applied to a panel of independent experts with professional experience related to Brazilian supplementary healthcare system. 39 QPIs were identified in the prior literature search and were evaluated in the first round. In the second round, the QPIs were classified according to the results of the coefficient of the Pearson variation (PV) and consensus rate (CR). The QPIs with a consensus among the panel of experts were classified within 5 domains.

RESULTS: 26 and 20 experts from four different Brazilian regions participated in the first and second round, respectively. In the first round, all 39 QPIs presented CR>70% and 2 new QPIs were added. In the second round, 59% of the QPIs presented a high degree of consensus (PV≤30%, CR≥80%), 5.1%, 15.4%, 10.3%, 15.4%, and 12.8%, respectively in the following domains: access, effectiveness, efficacy, efficiency, and safety. All 24 QPIs with a high degree of consensus were incorporated into the quality and performance program of providers of ambulatory health services and are used according to type, structure and area of each provider.

CONCLUSIONS: The main QPIs of providers of ambulatory health services are related to effectiveness (development of medical guidelines, occupation rate and length of stay in outpatient service, and others) and efficiency (time for urgency or emergency healthcare, correct and complete record of patient documentation, and others). Discordant QPIs among experts suggested the need for more research to prioritize what is most important to those receiving healthcare as well as to maintain the sustainability of the system.