Improving the quality of health care: Research methods used in developing and applying quality indicators in primary care

Campbell, Stephen; Braspenning, Jozé; Hutchinson, Allen; Marshall, Martin

doi:10.1136/bmj.326.7393.816

Cited by 496 publications

(247 citation statements)

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“…The questionnaire was elaborated after progressive stages of discussion and consensus among the research team and program experts. 6,12,19 A pilot questionnaire was answered and commented upon by a sample of 46 services from different states. The analysis of the answers provided was the basis for the final questionnaire, which comprised 112 multiple choice questions describing the institutional characteristics of the service (six questions), resource availability (30 questions), and all stages of the care process and management activities (76 questions).…”

Section: Introductionmentioning

confidence: 99%

Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil

et al. 2006

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ObjectiveIn the context of universal access to antiretroviral treatment, the results of the Brazilian AIDS Program will depend on the quality of the care provided. The aim of the present study was to evaluate the healthcare provided by outpatient services for the treatment of AIDS patients. MethodsThe present study was carried out in seven Brazilian States between 2001 and 2002. We evaluated the quality of the care provided to AIDS patients from the standpoint of resource availability and care process organization. A questionnaire comprising 112 structured questions addressing these aspects was sent to 336 services. ResultsResponse rate was 95.8% (322). Greater adequacy is seen for indicators of resource availability than for those of work organization. The supply of antiretroviral medication is sufficient in 95.5% of services. CD4 and viral load tests are available at adequate amounts in 59 and 41% of services, respectively. In 90.4% of services there is at least one non-medical professional (psychologist, nurse, or social worker). As to work organization, 80% scheduled the date but not the time of medical appointments; 40.4% scheduled more than 10 appointments per period; 17% did not have exclusive managers; and 68.6% did not hold systematic staff meetings. ConclusionsThe results indicate that, in addition to ensuring the more homogeneous distribution of resources, the program must invest in the training and dissemination of care management skills, as confirmed by the results of care process organization.

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Section: Introductionmentioning

confidence: 99%

Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil

et al. 2006

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“…A betegellátás minőségének javítása évtizedek óta fontos téma a világ legtöbb országának egészségügyében [1]. A minőségnek nincs általánosan elfogadott definíciója az egészségügyi rendszerekre vonatkozóan, a legtöbb szerző által használt megközelítés Donabedian klasszikus modelljén alapul, amely alapvetően a szerkezet (structure), a folyamat (process) és az eredmény (outcome) dimenziókat értékeli [2][3][4][5].…”

Section: Minőség Az Alapellátásbanunclassified

A háziorvosok teljesítményének minőségi értékelése. Mi a probléma a háziorvosi indikátorokkal?

Kolozsvári

Rurik

2016

Orvosi Hetilap

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Magyarországon a háziorvosi indikátorrendszert 2009-ben vezették be és azóta folyamatosan fejlesztik. A rendszer bizonyos számszerű elvárások alapján többletfinanszírozást ad a mérőszámokban jobban teljesítő háziorvosoknak. A szerzők a jelenleg használatos 16 felnőtt-és vegyes, valamint a 8 gyermekkörzeti indikátort elemzik, és rámutatnak azokra a tényezőkre, amelyek a háziorvosok munkáján kívül a mérőszámokat befolyásolják. A legfontosabbak: a betegek elvárásai, compliance-ük, a szakellátók tevékenysége, a szolgáltatók közötti nem megfelelő információáramlás és a nem megfelelő háziorvosi szoftver, amelynek fejlesztése szükséges. A szerzők véleménye szerint az anyagi motiváció szintjét is a jelenlegi többszörösére kellene emelni, a jelentési rendszer megváltoztatása mellett. Javasolják, hogy a szakmapolitikai és finanszírozói elvárások megfogalmazásával szakmai grémiumok alakítsák ki az indikátorokat, amelyeket fontosnak tartanak a hazai alapellátás színvonalának emeléséhez. Orv. Hetil., 2016, 157(9), 328-335. Kulcsszavak: alapellátás, finanszírozás, indikátorok, minőség, teljesítményértékelés Quality evaluation of primary care service performance What are the problems with the recent Hungarian primary care indicators?The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary.

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“…This quality definition has similarities to that suggested by the ASQ. The quality measures in health care assess three components: structure (resources such as staff, equipment), process (therapeutic interventions, prescribing, interactions with patients) and outcomes (end results of health care such as mortality and patient satisfaction) [22][23][24]. The measures used to obtain the patients' view can be classified into three categories: preferences, evaluations and reports.…”

Section: Customer Perspective In Quality Improvementmentioning

confidence: 99%

Money matters: exploiting the data from outcomes research for quality improvement initiatives

et al. 2009

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In recent years, there has been an increase in studies that have sought to identify predictors of treatment outcome and to examine the efficacy of surgical and nonsurgical treatments. In addition to the scientific advancement associated with these studies per se, the hospitals and clinics where the studies are conducted may gain indirect financial benefit from participating in such projects as a result of the prestige derived from corporate social responsibility, a reputational lever used to reward such institutions. It is known that there is a positive association between corporate social performance and corporate financial performance. However, in addition to this, the research findings and the research staff can constitute resources from which the provider can reap a more direct benefit, by means of their contribution to quality control and improvement. Poor quality is costly. Patient satisfaction increases the chances that the patient will be a promoter of the provider to friends and colleagues. As such, involvement of the research staff in the improvement of the quality of care can ultimately result in economic revenue for the provider. The most advanced methodologies for continuous quality improvement (e.g., six-sigma) are data-driven and use statistical tools similar to those utilized in the traditional research setting. Given that these methods rely on the application of the scientific process to quality improvement, researchers have the adequate skills and mind-set to embrace them and thereby contribute effectively to the quality team. The aim of this article is to demonstrate by means of real-life examples how to utilize the findings of outcome studies for quality management in a manner similar to that used in the business community. It also aims to stimulate research groups to better understand that, by adopting a different perspective, their studies can be an additional resource for the healthcare provider. The change in perspective should stimulate researchers to go beyond the traditional studies examining predictors of treatment outcome and to see things instead in terms of the ''bigger picture'', i.e., the improvement of the process outcome, the quality of the service.

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Improving the quality of health care: Research methods used in developing and applying quality indicators in primary care

Abstract: Before we can take steps to improve the quality of health care, we need to define what quality care means. This article describes how to make best use of available evidence and reach a consensus on quality indicators

Cited by 496 publications

References 20 publications

Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil

Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil

A háziorvosok teljesítményének minőségi értékelése. Mi a probléma a háziorvosi indikátorokkal?

Money matters: exploiting the data from outcomes research for quality improvement initiatives

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