status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 7
1.3.3 Methods for improving quality in general practice
Marshall and Campbell listed some methods used for improving quality in general
practice 19 . This review adds some other initiatives.
• Development of guidelines and clinical pathways. A guideline is a work
consisting of a set of directions or principles to assist the health care
practitioner with patient care decisions about appropriate diagnostic,
therapeutic, or other clinical procedures for specific clinical circumstances.
Practice guidelines may be developed by government agencies, by institutions,
by organizations such as scientific societies or governing boards or by expert
panels. They can be used for assessing and evaluating the quality and
effectiveness of health care in terms of measuring improved health, reduction
of variation in services or procedures performed, and reduction of variation
in outcomes of health care delivered. Pathways are schedules of medical and
nursing procedures, including diagnostic tests, medications, and consultations
designed to deliver an efficient, coordinated program of treatment (MeSH
definitions).
• Audit: based on structure and clinical indicators, it is a detailed review and
evaluation of selected clinical records by qualified professional personnel for
evaluating the quality of medical care (MeSH definition).
• Significant event analysis: this procedure uses a well-defined structure to
analyse errors, accidents or near accidents, to look for the causes and to
define actions to prevent them.
• Continuing medical education includes lectures, seminars and courses.
• Personal education: reading of journals, reviews and books.
• Learning diaries or ‘portfolios’ are tools used by he physicians to record their
personal learning project i.e., what they want to learn, the trigger for
learning, the resources and the outcome of this knowledge. 20, 21 The
portfolios have three functions: personal development, assessment and
learning. 22 23, 24
Those tools are used e.g. for the training of future GPs.
• Assessment of user’s care experience or satisfaction using questionnaires or
patient groups.
• Peer review in Local Quality Groups (LOK and GLEM) 25 : small groups of
physicians meet on a regular basis to discuss quality topics. Peer review also
refers to the visit of practices by peers.
• Accreditation and certification are formal processes and highly summative in
nature to check the compliance with a set of standards. Individuals apply for
certification on a voluntary basis. Certification gives a professional status e.g.,
certification for a medical specialty (MeSH definition). The Belgian term
‘accreditation of GP’ refers more specifically to a certification procedure of
the individual practitioner.
• Feedback from centrally collected data and physician profiling: may be
formative or summative in order to identify outliers.
• The public annual reports of the practices enhance the transparency for the
society (stakeholders like patients, insurance companies/funds and
accreditation bodies). It contains the status of the administrative and
operational functions and accomplishments of an institution or organization
(MeSH definition).
Two certification models, currently of use in industry, may also be relevant to general
practice:
• ISO 9001:2000 is a quality system used in industry. 26 The International
Organization of Standardization is hardly referenced in the international
literature on quality improvement in health care for general practice. 27
• The European Forum Quality Award Model (EFQM) was introduced in 1992
and is a framework for assessing the management of organizations.