Quality indicators for general practice: which ones can general practitioners and health authority managers agree are important and how useful are they?

Abstract

Acceptable face valid indicators were identified for all domains except gatekeeping. However, the indicators rated by the sample do not cover all aspects of care. No indicators were proposed for use by health authorities relating to effective communication, care of acute illness, health outcomes or patient evaluation. Although it is possible to develop indicators of general practice care which have face validity in the view of both GPs and managers, these will be very partial measures of quality. In the indicators used in this study, no explicit distinction was made between indicators designed to assess minimum standards with which all practices should comply, and indicators which could be used to reward higher levels of performance. Failure to separate these will result in antagonism from practitioners to quality improvement initiatives in the NHS, and a failure to engage the profession in improving quality of care.

On comparing the performance of primary care providers

“…However, it would be interesting to investigate the reasons why singlehanded practices in the Netherlands scored better in terms of accessibility and availability of care. Campbell et al (1998) have undertaken a survey of Health Authorities (HAs) in England to identify PIs in use or in consideration for use in general practice. A total of 240 indicators were identified in terms of access, organisational performance, preventive care, chronic disease management, prescribing and gatekeeping (appropriateness of referral decisions).…”

AHRQ Prevention Quality Indicators to assess the quality of primary care of local providers: a pilot study from Italy

“…[3][4][5] Starting from the 1970s, 6 a number of quality indicators for primary health care has been proposed, 7 but their validity has often remained questionable. 3,8,9 An important progress was achieved in the early 1990s with the concept of 'potentially avoidable' or 'ambulatory care sensitive' hospitalizations, 10 which were extensively used to indirectly evaluate the performance of primary health care in several countries.…”

“…[3][4][5] Starting from the 1970s, 6 a number of quality indicators for primary health care has been proposed, 7 but their validity has often remained questionable. 3,8,9 An important progress was achieved in the early 1990s with the concept of 'potentially avoidable' or 'ambulatory care sensitive' hospitalizations, 10 which were extensively used to indirectly evaluate the performance of primary health care in several countries. [11][12][13][14][15][16] Based on the assumption that the hospitalization for several chronic and acute conditions can be prevented with timely and appropriate ambulatory care, 17 the Agency for Healthcare Research and Quality (AHRQ) developed a set of 14 primary care quality measures, named 'prevention quality indicators' (PQIs), which were first released in 2000 18 and which have been validated in the USA to compare the performance of national [19][20][21][22][23][24][25][26][27][28] and local (counties) [29][30][31] providers.…”

An application of value-based DEA to identify the best practices in primary health care

“…For other units, the proposed numbers of medical consultations for registered patients would be impossible to achieve. That led to formulation (5) in which the value gap relatively to the efficient peer is distributed in a balanced way on all the factors (see proposal 3 in Table 10). …”

“…Most of these studies tend to rely on the use of performance indicators (PIs) to measure health service delivery and quality of care [2][3][4][5][6][7], but the different PIs are analysed individually. Thanassoulis et al [8] and…”