Improving quality of care in general practices by self-audit, benchmarking and quality circles

Mahlknecht, Angelika; Abuzahra, M.; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas

doi:10.1007/s00508-016-1064-z

Cited by 16 publications

(11 citation statements)

References 17 publications

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“…Our iterative searches returned 82 background papers (S3 File). Among retrieved papers, we deemed eligible and relevant 21 systematic reviews [33–53], 14 randomised controlled trials [54–67], 11 non-randomised controlled studies [68–78], 11 qualitative studies [79–89], and one mixed methods study [90] (S4 File). The systematic reviews, randomised controlled trials, cohort and controlled before-and-after studies each described and evaluated the processes or techniques QCs used.…”

Section: Resultsmentioning

confidence: 99%

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae– A scoping review

et al. 2018

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Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.

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Section: Resultsmentioning

confidence: 99%

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae– A scoping review

et al. 2018

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“…The groups choose a topic they want to learn more about or a quality aspect which they want to improve in their practice. They decide on how to approach and solve the issue, and they create space for reflective thinking to improve clinical practice (1, 5, 15, 22, 45, 47–55).…”

Section: Resultsmentioning

confidence: 99%

Quality circles for quality improvement in primary health care: their effectiveness, gaps of knowledge, origins and significance – a scoping review

Rohrbasser

Harris

Mickan

et al. 2018

Preprint

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Quality circles for quality improvement in primary health care 2 40 Abstract 41 Background 42 Quality circles, or similarly structured small groups in primary health care, such as peer review 43 groups, consist of 6 to 12 professionals from the same background who meet regularly to improve 44 their standard practice. This paper reports the results from a scoping search performed to clarify 45 possible effectiveness, knowledge gaps, underlying concepts and significance.46 Objectives 47 To gain insight into knowledge gaps and understanding of the effectiveness, origins and significance 48 of quality circles.49 Methods 50 A search strategy was developed starting with 'quality circle' in PubMed and the index terms from 51 those articles revealed were then used as search terms to identify further papers. Repeating this process 52 in collaboration with a librarian, search strings relating to quality circles were built, and databases 53 searched up to December 2017. Any paper on structured quality circles or related small group work in 54 primary health care was included when relevant to the objectives. Results 56From 11973 citations, 82 background papers and 58 key papers were identified, in addition to 12 57 books and 10 websites. 19 studies, one paper summarizing three studies and one systematic review 58 suggest that quality circles can be effective in behaviour change, though with varying effect sizes.59 Quality circles and their techniques are complex, as they are not standardized, and changes seem to 60 depend on the topic and context, which requires further research into how and why they work in order 61 to improve them. From their origins in industry, they are now used in primary health care in many 62 countries for continuous medical education, continuous professional development and quality 63 improvement. 64 Conclusion 65The evidence on quality circles indicates that they can successfully change general practitioner 66 behaviour. As they are a complex intervention, theory-driven research approaches are needed to . CC-BY 4.0 International license It is made available under a (which was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint . http://dx.doi.org/10.1101/387605 doi: bioRxiv preprint first posted online Aug. 8, 2018; Quality circles for quality improvement in primary health care 3 67 understand and improve their effectiveness. This is of major importance because they play an 68 important role in quality improvement in primary health care in many countries. 79There are systematic reviews (SRs) on the tools used in these groups but there is still doubt as 80 to whether they make participants improve their practice, even if the tools are used in combination.81 This paper reports the results of a scoping review to map areas of uncertainty regarding QC 82 effectiveness, thereby indicating where further research is needed. It maps size and type of evidence 83 and describes original intentions and report...

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“…The Austrian IQuaB-project (Improving Quality by Benchmarking) faced similar barriers. Problem areas involved plurality in EHR softwares, diverse and missing EHR software functions, unstructured databases and limited data extraction options [44,45].…”

Section: Main Findingsmentioning

confidence: 99%

“…However, the proportion of patients in our study who ever had a spirometry documented was only 46%. This finding does not seem to be limited to Germany: International studies report the proportion of COPD patients in general practice with a spirometry recorded in their EHR (ever) to be at 11.7% for Austria [44] and 60.9% for Italy [34].…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Clinical governance as professional self-reflection: A cross-sectional study assessing the quality of COPD care in German general practice

Heinmüller

Frank

Höfle

et al. 2019

Preprint

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BACKGROUND In the United Kingdom, a system of clinical governance (CG) which was introduced “top-down” by politics tries to ensure high quality health services. In general practice, the meeting of quality targets was linked to financial incentives causing several negative effects. In Germany CG is not established. We advocate a “bottom-up” CG for German general practice to avoid these negative effects. AIMS To test “bottom-up” CG within a network of general practices (GPN) using chronic obstructive pulmonary disease (COPD) as example disease. As a first step, we wanted to assess the current care quality of the GPN for COPD. Furthermore, feasibility of a care quality assessment through routine data from electronic health records (EHR) should be evaluated. METHODS A cross-sectional study was conducted. Quality indicators (QI) were developed according to COPD guidelines. COPD patients of the GPN ≥40 years were identified. For the determination of QI, data were retrieved from EHR. RESULTS In total, 2568 COPD patients were identified. Their mean age was 67 (SD±12) years, 49% were male. Thirty-five percent had a parallel diagnosis of asthma. There was no documentation of any spirometry for 54% of patients, 29% had a spirometry within the previous year. An influenza vaccination was administered to 37% within the preceding twelve months, 12% received a pneumococcal vaccination in the last six years. Smoking status was documented for 44% within the last year. Several QI were not assessable. CONCLUSION Care quality assessment by means of EHR data was challenging due to non-standardized documentation. Assessable QI indicated suboptimal COPD care. Our results confirm the need for CG in German general practice and better EHR softwares supporting CG through structured documentation and feedback for GPs. We are planning to proceed with “bottom-up” CG by introducing quality improvement measures within the GPN in answer to this study.

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Improving quality of care in general practices by self-audit, benchmarking and quality circles

Cited by 16 publications

References 17 publications

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae– A scoping review

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae– A scoping review

Quality circles for quality improvement in primary health care: their effectiveness, gaps of knowledge, origins and significance – a scoping review

Clinical governance as professional self-reflection: A cross-sectional study assessing the quality of COPD care in German general practice

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