status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 1
Table of contents
Scientific Summary
1 INTRODUCTION: QUALITY IN GENERAL PRACTICE 3
1.1 CORE COMPETENCES OF GENERAL PRACTICE 3
1.2 ACCOUNTABILITY IN HEALTH CARE 4
1.3 QUALITY IN GENERAL PRACTICE 4
1.3.1 General definitions 4
1.3.2 Improving quality in general practice: the quality cycle 6
1.3.3 Methods for improving quality in general practice 7
1.3.4 Levels of quality development initiatives 8
1.4 QUALITY DEVELOPMENT IN GENERAL PRACTICE IN BELGIUM 9
1.4.1 Legal framework 9
1.4.2 Quality development initiatives in the Belgian context of general practice 9
1.4.3 Evaluation of the outcomes of Continuous Medical Education, LOKs/GLEMs and
feedbacks in Belgium 10
1.5 CHALLENGE TODAY AND OBJECTIVE OF THIS REPORT 11
1.6 STRUCTURE OF THIS REPORT 11
2 QUALITY SYSTEM IN GENERAL PRACTICE: ANALYSIS OF FIVE SELECTED COUNTRIES 12
2.1 INTRODUCTION 12
2.2 METHODOLOGY 12
2.2.1 Selection of the countries 12
2.2.2 Search strategy in electronic databases 12
2.2.3 Grey literature: electronic sources and additional information on the selected
countries 13
2.3 RESULTS OF THE LITERATURE STUDY 13
2.3.1 Selected reviews and papers 13
2.3.2 Description of the selected reviews 14
2.3.3 Effectiveness of peer reviews, practice visits and audits 15
2.3.4 Quality indicators 15
2.3.5 Precursors, enablers and incentives for implementing a quality development
framework 16
2.3.6 The Quality Outcomes Framework in the UK 16
2.3.7 Pan European initiatives 17
2.3.8 Lack of evidence on the effects of quality initiatives on outcomes at the patient level 18
2.3.9 Limitations of the literature study 19
2.3.10 Discussion of the literature search 19
2.4 DESCRIPTION OF THE QUALITY SYSTEM IN THE FIVE SELECTED COUNTRIES 20
2.4.1 France 22
2.4.2 Germany 25
2.4.3 The Netherlands 28
2.4.4 United Kingdom 30
2.4.5 Australia 34
2.5 SUMMARY AND CONCLUSIONS OF THE ANALYSIS OF FIVE COUNTRIES 38
2.5.1 Steppingstones for a quality framework: a vision based on a national policy 40
2.5.2 The components of a quality framework 40
2.5.3 Purpose of the system: summative and formative use 40
2.5.4 Pro and contras of clinical indicators: the UK experience 40