What Defines a High-Performing Health Care Delivery System: A Systematic Review  Sangeeta C. Ahluwalia, PhD, Cheryl L. Damberg, PhD, Marissa Silverman, MPH, Aneesa Motala, BA, Paul G. Shekelle, MD  Joint Commission Journal on Quality and Patient Safety  Volume 43, Issue 9, Pages 450-459 (September 2017) DOI: 10.1016/j.jcjq.2017.03.010 Copyright © 2017 The Joint Commission Terms and Conditions

Figure 1 This flow diagram presents the different stages of article identification, review, and selection. This process resulted in a total of 57 articles that were included in the analysis and contributed to the data synthesis. This flow diagram is presented in accordance with Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–1012. Joint Commission Journal on Quality and Patient Safety 2017 43, 450-459DOI: (10.1016/j.jcjq.2017.03.010) Copyright © 2017 The Joint Commission Terms and Conditions

Figure 2 This chart displays the number of identified articles that used each of the various dimensions of “high performance,” as identified through the review. For example, 53 of the included articles used clinical quality in their definition of high performance. Joint Commission Journal on Quality and Patient Safety 2017 43, 450-459DOI: (10.1016/j.jcjq.2017.03.010) Copyright © 2017 The Joint Commission Terms and Conditions

Figure 3 This figure presents the included articles by the number of dimensions reflected in their definitions of “high performance” and by the specific combinations of dimensions reflected in the definition. For example, 11 of the included articles used definitions of high performance covering 2 dimensions. Of these 11 articles, 7 used the combination of clinical quality and cost in their definitions of high performance. Joint Commission Journal on Quality and Patient Safety 2017 43, 450-459DOI: (10.1016/j.jcjq.2017.03.010) Copyright © 2017 The Joint Commission Terms and Conditions