Implementing occupational therapy quality indicators in a large healthcare system: lessons from a 5-year performance monitoring study

Background: Performance measurement tools, such as quality indicators, shape how services are organized, delivered, and evaluated; they are central to monitoring and improving health system performance. This study examines 5 years of implementing occupational therapy quality indicators within a large public healthcare organization and assesses how structured performance measurement can support routine monitoring, accountability, and quality improvement in occupational therapy service delivery. Method: We conducted this retrospective, repeated cross-sectional study within Clalit Health Services, Israel’s largest public healthcare organization, serving more than 4.9 million members across nine districts. We analysed performance trends (2021–5) for five occupational therapy quality indicators implemented system-wide: children–parental conversations, children-treatment interruption, frail older adults, stroke, and hip fracture. Data were extracted from electronic health records and administrative databases. The analytic sample included all Clalit Health Services members eligible for at least one occupational therapy quality indicator during the study period. Performance for each occupational therapy quality indicator was calculated as numerator/denominator * 100 national-level longitudinal trends and subgroup associations were analysed. Results: Four of the five occupational therapy-quality indicators improved significantly over time. From 8.1% to 3.7%, occupational therapy service delivery to frail older adults increased from 51.8% to 77.4%, and occupational therapy after stroke increased from 52.2% to 59.9% (P < .001 for all). The hip fracture indicator showed no statistically significant overall change, increasing slightly from 71.3% to 71.8% (P = .706), despite fluctuations during the monitoring period. Methodological changes to the denominator definition highlighted the sensitivity of performance metrics to operational definitions. Subgroup analyses further identified socio-demographic and geographic variation in occupational therapy quality indicator performance, particularly by age, socio-economic position, ethnicity, and peripherality, although patterns differed across indicators. Conclusions: Implementing occupational therapy quality indicators within a nationwide community rehabilitation system enabled routine longitudinal monitoring of access, timeliness, family engagement, continuity of care, and service consistency. These indicators provided a structured framework for identifying service gaps, improving national-level visibility, and informing organizational decision-making. The findings support the feasibility and value of profession-specific quality indicators as a scalable model for performance monitoring and quality improvement in rehabilitation and allied health services. Future research should link occupational therapy quality indicator performance to patient-level functional, participation, and quality-of-life outcomes and examine geographic and socio-demographic inequities in service delivery.