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Indicators of quality in primary healthcare.
Berg, M.J. van den, Bakker, D.H. de. Indicators of quality in primary healthcare. European Journal of Public Health: 2004, 14(4 Suppl.) 31. Abstract. 12 th Annual EUPHA meeting: Urbanisation and health: new challenges in health promotion and prevention in Oslo, Norway, 7-9 october 2004.
Background: GPs play a pivotal role in the Dutch healthcare system. Since GPs have a so-called gatekeeper-function, the overwhelming majority of medical problems is served by GPs. The Inspectorate of Health Care (IHC) is charged with the supervision of public health, including the quality of care provided by GPs. Since it is not possible to visit every surgery on a regularly basis, NIVEL developed a rational model based on quality-indicators. In contrast to many other indicators these indicators focus primarily on risks for public health instead of organisational and financial aspects. A risk, in this context, is considered to be the chance of undesirable effects on public health that is caused by shortcomings in the performance of caregivers. The indicators enable the IHC to get there priorities right and offer the opportunity to determine where and when supervision should take place. Aim: a) To develop a short list of indicators that can be used by the IHC to determine inspection priorities and that provide a good indication of the quality of care and risks for public health in general practice. b) To describe the actual state of the art in Dutch general practice. Methods: A selection of relevant aspects to base the indicators on was made on the basis of literature and professional standards, also the measurability was an important criterion. To validate the indicators, data from the 2nd National survey of general practice were analysed. 104 practices with 195 GPs and 400,000 patients participated in this study. The GPs registered among other things diagnose, type of consultation, prescription, referral and type of consultation. Besides, approximately 13,000 patients and 195 GPs were interviewed and 2784 consultations were videotaped. Case-mix variables were taken into account. The data were analysed using multilevel analyses. Results: Indicators were developed for accessibility, prevention activities, rational prescription behaviour, prescription of antibiotics, referrals, disease management, patient-centeredness. The results revealed remarkable differences between GPs and practices on many aspects. The results support the idea that indicators can be useful tool for the IHC. Some examples of useful indicators are: number of prescriptions of antibiotics per 1000 patients, waiting time (between the first contact and the consultation), and averages scores on scales for patient-centeredness and the provision of information. Conclusions: Although there is not a one-on-one relationship between indicators and quality of care, indicators can be a useful tool to develop a rational strategy to determine inspection priorities.
Background: GPs play a pivotal role in the Dutch healthcare system. Since GPs have a so-called gatekeeper-function, the overwhelming majority of medical problems is served by GPs. The Inspectorate of Health Care (IHC) is charged with the supervision of public health, including the quality of care provided by GPs. Since it is not possible to visit every surgery on a regularly basis, NIVEL developed a rational model based on quality-indicators. In contrast to many other indicators these indicators focus primarily on risks for public health instead of organisational and financial aspects. A risk, in this context, is considered to be the chance of undesirable effects on public health that is caused by shortcomings in the performance of caregivers. The indicators enable the IHC to get there priorities right and offer the opportunity to determine where and when supervision should take place. Aim: a) To develop a short list of indicators that can be used by the IHC to determine inspection priorities and that provide a good indication of the quality of care and risks for public health in general practice. b) To describe the actual state of the art in Dutch general practice. Methods: A selection of relevant aspects to base the indicators on was made on the basis of literature and professional standards, also the measurability was an important criterion. To validate the indicators, data from the 2nd National survey of general practice were analysed. 104 practices with 195 GPs and 400,000 patients participated in this study. The GPs registered among other things diagnose, type of consultation, prescription, referral and type of consultation. Besides, approximately 13,000 patients and 195 GPs were interviewed and 2784 consultations were videotaped. Case-mix variables were taken into account. The data were analysed using multilevel analyses. Results: Indicators were developed for accessibility, prevention activities, rational prescription behaviour, prescription of antibiotics, referrals, disease management, patient-centeredness. The results revealed remarkable differences between GPs and practices on many aspects. The results support the idea that indicators can be useful tool for the IHC. Some examples of useful indicators are: number of prescriptions of antibiotics per 1000 patients, waiting time (between the first contact and the consultation), and averages scores on scales for patient-centeredness and the provision of information. Conclusions: Although there is not a one-on-one relationship between indicators and quality of care, indicators can be a useful tool to develop a rational strategy to determine inspection priorities.
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