status quo of quo vadis? - KCE

More documents

Recommendations

Info

18 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 2.3.7.3 The Maturity Matrix The maturity matrix aims to locate a practice in the scope of quality development. This formative and informal instrument is used in association with an educational practice visit. 74, 75 The authors start from the conceptual view that there are stages in the development of quality within practices. Using a visual representation, the results give a snapshot on the eleven ´maturity´ indexes. This instrument is now translated into various languages and currently tested within European GP practices. The following domains are covered and in each domain a range of growth, indicating the maturity of the practice on the domain is scored: • Prescribing (one extreme is relying on written patient record as compared to the use of fully coded data on consultations), • Audit of clinical performance (no clinical audit as compared to systematic audits with results shared by with the public), • Use of guidelines (no guidelines policy in the practice as compared to full integration of guidelines into the clinical management systems), • Access to clinical information (no system to retrieve the available evidence as compared to all clinicians skilled to find relevant clinical information on internet), • Availability of prescribing data (no prescribing data available in the practice as compared to regular visits of a specialist to give independent advice on prescribing), • Human resource management (informal arrangements as compared to written contracts between staff and practice and skill mix review), • Continuing professional development (from no arrangement to CME budgets reviewed annually), • Risk management (no arrangements for handling patient complaints as compared to planned evaluation of significant event analysis), • Practice meetings (no arrangements as compared to planned practice meetings with social services), • Sharing information with patients (no information for patients as compared to individually tailored information provided to patients about harms and benefits of treatments), • Learning from patients (no system for collecting feedback as compared to patient engagement as a part of the routine management process). 2.3.8 Lack of evidence on the effects of quality initiatives on outcomes at the patient level The evidence that a quality development system works at the patient level is very scarce. This literature review only identified two papers that considered the relation between the use of a quality development framework and patient experience. The first study found a positive correlation between QOF total score and patient satisfaction. These authors therefore question the construct validity of the set of indicators of the QOF. 76 In Australia, patients of GPs who went through the accreditation process also reported higher satisfaction. 77 Contencin et al. identified the cost-effectiveness of any quality system as an important issue. 40 However, the selected publications seldom mention the cost-effectiveness of quality systems and quality development initiatives. Some authors state that particular systems may waste resources as for example clinical audit. 47 Finally, the effect of a quality system on patient outcomes also depends on the modalities for implementation within the health care context. In most European countries, the participation to quality development initiatives relies on voluntary participation. This mechanism might weaken the global effect on patients' outcomes at the population level.
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 19 However, as stated above, incentives can enhance the participation of the GPs: UK doctors largely increase their income if they adhere to the QOF. In Germany, a formal mandatory system exists: it will be further detailed in the description of the country. 40 2.3.9 Limitations of the literature study A major problem in the analysis of the literature on quality development in general practice is the variation of the definition of this specialty according to the health care systems. To keep the concept of general practice as homogeneous as possible, this review focuses on 5 countries with health care systems similar to Belgium. However, there are also probably lessons to be learned from other efficient health care delivery structures (as the HMOs in the US). Nearly all papers gathered data from self-selected practices. Most findings are therefore difficult to generalize to the whole population of general practitioners. Furthermore, there is considerable bias linked to the countries selected. The literature from France and Germany, both non English-speaking countries is scarce. Researchers from both countries did participate as co-authors in some publications. 74, 78, 43, 75, 79 On the other hand, researchers from the Netherlands and the UK have often been working in consortia with many interactions between researchers. 2.3.10 Discussion of the literature search This literature search highlights the paucity of evidence on evaluation of quality systems in general practice. On the opposite, there are many papers on quality for specific pathologies like diabetes care, which is an important issue, although a small part only of the GP’s daily workload. Quality development initiatives are growing in all selected countries and the debate of quality development in GP is only emerging. Major points for the development and implementation of successful quality systems are the followings: • Policy and leadership are crucial. This literature search identified the UK and Australia as leading countries. In both countries, governments positively influenced the quality agenda. Legislation seems one of the most powerful enablers. • Incentives are important for the success of any quality development system. Financial incentives may be in particular powerful, as shown in the UK literature. • This literature review confirms the findings of the previous report i.e. the need for a careful selection and field test of the different types of indicators (clinical, organisational and patient experiences). The next chapter details the quality systems in the five selected countries in order to complete the information from this systematic literature review. This detailed analysis highlights the conditions for implementation, the opportunities and difficulties linked to quality development systems in general practice.
Page 1 and 2: Kwaliteitsbevordering in de huisart
Page 3 and 4: Kwaliteitsbevordering in de huisart
Page 5: Hoe refereren naar dit document? Re
Page 8 and 9: ii Kwaliteitsbevordering in de huis
Page 10 and 11: iv Kwaliteitsbevordering in de huis
Page 12 and 13: vi Kwaliteitsbevordering in de huis
Page 15 and 16: KCE Reports 76 Quality development
Page 31: KCE Reports 76 Quality development
Page 35 and 36: 21 Quality development in general p
Page 53 and 54: KCE Reports Quality development in
Page 83 and 84:
KCE Reports 76 Quality development
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Health policy KCE Reports 76 Qualit
Page 151:
Page 154 and 155:
Wettelijk depot : D/2008/10.273/18
Page 156 and 157:
38. Baarmoederhalskankerscreening e
show all

status quo of quo vadis? - KCE

Create successful ePaper yourself

Delete template?

Save as template?