How to move towards community based service delivery?

Aim: Community based primary health care offers in potential the opportunity to tailor health service delivery to the needs and demands of the local population. Up to now, there is no clear cut method to do this. In a pilot benchmark for general practices, data were collected on demand and supply-side. The aim is to develop a method to evaluate health service delivery in relation to the local needs and demands. Design and Methods:Needs were measured by extracting data related to the practice’s service area out of the population-based-survey on health status and risk factors, carried out by the municipal health service. The demand was measured through self-administered questionnaires sent to random samples of patients from the participating practices (CQ-Index). Per practice, 100 patients were asked to complete a questionnaire on the importance they attach to items related to the service delivery, and 400 patients were questioned about their experiences.
Results: Seventeen general practices in Rotterdam, the Netherlands, participated in the study. Considerable variation was observed in the health status and health risks between the populations served. The combination of information on aspects of service patients deem most important and their experience resulted in practice-specific strength-weakness analysis. Practices received a personal feedback-report in which their results were compared with group results. Meetings were held to analyse the results and to define strategies for improvement. Conclusion: Benchmarking is a powerful strategy to stimulate general practices to orientate their services more towards the needs and demands of their community. This experiment shows the added value of combining various data sources in that endeavour.