Performance Indicators for Primary Care Groups: An Evidence Based Approach

Wessex Institute for Health Research and Development, University of Southampton, Health Care Research Unit.
BMJ Clinical Research (Impact Factor: 14.09). 12/1998; 317(7169). DOI: 10.1136/bmj.317.7169.1354
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    • "One of the priorities of health systems is ensuring the quality of primary care (Nietert et al. 2007). To achieve this objective, multiple indicators have been developed to assess the quality of clinical practice (McColl et al. 1998). Nonetheless, utilization of numerous partial indicators makes it difficult to achieve a global interpretation and to compare individuals as well as groups or centres. "
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    ABSTRACT: The development of electronic medical records has allowed the creation of new quality indicators in healthcare. Among them, synthetic indicators facilitate global interpretation of results and comparisons between professionals. A healthcare quality standard (EQA, the Catalan acronym for Estàndard de Qualitat Assistencial) was constructed to serve as a synthetic indicator to measure the quality of care provided by primary care professionals in Catalonia (Spain). The project phases were to establish the reference population; select health problems to be included; define, select and deliberate about subindicators; and construct and publish the EQA. Construction of the EQA involved 107 healthcare professionals, and 91 health problems were included. In addition, 133 experts were consulted, who proposed a total of 339 indicators. After systematic paired comparison, 61 indicators were selected to create the synthetic indicator. The EQA is now calculated on a monthly basis for more than 8000 healthcare professionals using an automated process that extracts data from electronic medical records; results are published on a follow-up website. Along with the use of the online EQA results tool, there has been an ongoing improvement in most of the quality of care indicators. Creation of the EQA has proven to be useful for the measurement of the quality of care of primary care services. Also an improvement trend over 5 years is shown across most of the measured indicators. The online version of this article (doi:10.1186/2193-1801-2-51) contains supplementary material, which is available to authorized users.
    Full-text · Article · Dec 2013 · SpringerPlus
    • "However, as recognised by McColl et al. (1998), primary care delivery is not solely about applying the guidelines from clinical research. There are other important dimensions of performance, which would not be adequately monitored using this set of PIs, such as patient satisfaction and resources used. "
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    ABSTRACT: In the past few years primary health care has been characterised as central to the development of the National Health Service in the United Kingdom. Furthermore, performance assessment is seen as a way of achieving care of high standards. Performance indicators and targets are being developed to assess primary care providers, and to develop financial incentives. However, the number of studies that have compared the performance of primary care providers is limited and the existing approaches to evaluation are open to improvement.In this paper, we provide a critical review of the studies that have focused on the evaluation of primary health care providers, with particular reference to the use of the non-parametric technique Data Envelopment Analysis. We conclude that most studies focus on structure and outputs, without consideration of outcomes – the ultimate measure of performance – and tend to be of a summative rather than formative nature.
    No preview · Article · Mar 2008 · European Journal of Operational Research
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    • "The third framework is based on the closely related themes of evidence based medicine and quality [26,27,28]. The realisation that there are large variations of clinical performance, far beyond the variation attributable to patient factors, has led to the interest in standardisation based on the best available evidence [29], distributed as widely as possible [30]. "
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    ABSTRACT: Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process. It is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals.
    Full-text · Article · Feb 2000 · BMC Family Practice
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