status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 5
Family Doctors (WONCA) provided a working definition as ´the best outcomes
possible given available resources and the preference and values of patients´.
Campbell et al. suggest two approaches to define quality in health care. 14 In the generic
approach, a single statement covers all aspects of quality of care. In disaggregated
definitions one focuses on key attributes, each of one represents an inherent
characteristic of quality. For instance, safety, access and clinical quality could be
dimensions to address.
DIMENSIONS OF QUALITY IN GENERAL PRACTICE
The former KCE report also listed the dimensions of quality of care. 3 The addition of
some elements from Campbell’s work enhances their applicability to the GP setting. 14
• Safety: avoiding injuries to patients from the care intended to help them;
• Access to care: patients should be able to get access to services. The services
are accessible in terms of distance, time, without any legal, social or financial
barrier;
• Clinical effectiveness: the health professionals should be competent, provide
services based on scientific knowledge to all who could benefit and refrain
from providing services to those not likely to benefit;
• Patient centeredness: providing care that is respectful of and responsive to
individual patient preferences and needs whilst ensuring that patient values
guide major clinical decisions;
• Timeliness: avoiding delays potentially harmful;
• Equity of care: services should be available to all people. The quality of care
should not vary because of personal characteristics such as gender, ethnicity,
geographic location, and socioeconomic status;
• Efficiency of care: the society should get value for money by avoiding waste,
including waste of equipment, supplies, ideas, and energy;
• Continuous and integrative: all contributions should be well integrated to
optimise the delivery of care by the same health care provider throughout
the course of care (when appropriate), with appropriate and timely referral
and communication between providers.
These dimensions put emphasis on the fact that values underpin the assessment of
quality of care. These values often remain implicit but should be clarified when thinking
about a quality policy and quality system.
USE OF TERMS
Many terms have been used to make the concept ‘quality’ operational in general
practice. 15 The most frequently used ones are listed here.
Quality assessment identifies discrepancies between a proposed level of care and the
actual quality of care after careful measurement. Quality assessment is usually
performed by the profession at the individual level. Discrepancy might occur between
the facets under study within the quality assessment. The proposed level of care always
reflects choices made by one party. For instance some may argue that the consultation
length is a valid indicator to assess the quality of a consultation while others would
rather refer to the patient satisfaction.
Quality assurance deals with achieving acceptable levels of care and is often initiated by
purchasers or payers of care. Clinical audit aims at raising performance in one or only a
limited clinical area and relates to local needs.
Continuous quality improvement aims at improving the whole system and tries to limit
unintended variation in the care processes. The implementation of a permanent system
of quality management involves the whole practice team. 15
The European Association for Quality In General Practice/Family medicine EQuiP (a
network of WONCA Europe) adopted the terms ‘Quality Development’. It focuses on
the whole process and integration of different methods to improve the quality of care.