status quo of quo vadis? - KCE

More documents

Recommendations

Info

28 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 The easiest program with the most participating GPs may not have a quality level similar to the most intensive program. The impact on the quality of care of these systems has not yet been assessed. A study on the outcome of the different systems can be very interesting to decide on which quality framework to choose. 2.4.3 The Netherlands 2.4.3.1 Organisation of the health care system, with focus on family medicine/general practice The Netherlands has about one GP per 2300 inhabitants. GPs have role of gatekeeping. There is a trend towards group practice. Ancillary staff always helps the practice as 0.8 FTE is included in its budget. Now practices can hire management personnel ('praktijkondersteuner'), often specially trained practice nurses, to help to manage the practice and to care for special groups of patients (like patients with diabetes or chronic obstructive disease). They are present in more than 50% of the practices. Patients are listed and the remuneration of the GP depends on the number of listed patients. 82 Until 2006, the Dutch health care organisation was organised around general practitioners, the social health care (i.e. services for newborns, homecare for the elderly) and hospitals, most of which that were non-profit bodies. 82 Since 2006, political forces have changed the entire system. Insurance companies are in free enterprise and in what is called regulated competition. Also hospitals, social health institutions and GPs should compete and show more ´entrepreneurship´. The budgets come from direct payments (not related to income) to the health insurance companies and the other part is tax based, related to income. All citizens have to be insured and registered on a GP list. The payment system for GPs changed considerably. GPs are paid on a mixed basis i.e. capitation and fee for service: either for specific activities (diagnostic and therapeutic services like ECG, spirometry, minor surgery, terminal care) or extra staff for disease management. They also get financial bonuses for quality development activities like practice accreditation or quality development projects in their own practices. 86 2.4.3.2 Quality development in action: culture, legislation, financing, organisation and implementation BACKGROUND In 2003 the Ministry of Health announced measures for improving quality both in hospitals and in general practice. These measures focus on transparency, quality development using performance indicators, innovation and efficiency with priority on patient safety and patient-centred delivery of care. The Dutch Inspectorate of Health Care supervises the performance with the help of two research institutions: Nederlands Instituut voor onderzoek van de gezondheidszorg (NIVEL) and Rijksinstituut voor Volksgezondheid en Milieu (RIVM). They monitor performance and support transparency to the patients. 107 In the nineties the Dutch College of General Practitioners developed practice visits. Today, the College offers continuing education programmes (‘DKB paketten’) for general practitioners covering the fields of ´knowledge´ (i.e. guidelines), ´learning´ (i.e. learning packages, the toolbox), ´doing´ (i.e. patient leaflets) and ´assessing´ (including practice accreditation). PRACTICE GUIDELINES The Netherlands developed a set of more than 70 guidelines as well as transmural consensus pathways and primary care collaboration guidelines. The aim is to update them every five years. PEER REVIEW GROUPS All GPs are supposed to participate in assessment groups and over 80% participate in Pharmaceutics assessment groups (FTO) relating to their prescriptions. New initiatives
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 29 are Diagnostic assessment in groups (DTO), Transmural joint agreements, assessment on prescriptions and treatment (FTTO) and Travel advice assessment groups. QUALITY BOX The quality box, designed for individual practices, aims at making a quick go through some aspects of the practice. The self-assessment topics include the use of a practice computer, practice organisation and some clinical indicators of chronic diseases. After a ´quick scan´ the GP may choose some issues to work on. This Quality box is used for accrediting purposes, to select practices for vocational training or for selecting practices to allocate practice nurses (personal communication). PRACTICE ACCREDITATION The College supervise the organisation of the practice accreditation but an independent organisation has been installed in 2005. The practice accreditation is a three year process. The practice establishes first a relation with a practice consultant. The practice quality coordinator (doctor, manager or nurse practitioner) makes a plan with the practice-consultant. During one year, the practice collects data on: • Practice organisation, • Medical indicators, • Patient satisfaction. Efforts are required to improve data collection in order to measure the practice performance. This starts with the proper use of ICPC coding and the organisation of medical records. The practice consultant reviews these data and suggests priority areas for improvement. The practice designs a provisional plan for improvement of identified substandard aspects and sends this plan to the practice consultant. After an agreement procedure between the practice coordinator, the team and the practice-consultant, they agree on a final plan. 108 Anonymous data are transmitted to the research centre WOK at the University of Nijmegen for analysis. Currently, about 400 practices (1000 GPs) have gone through the accreditation process and the NHG claims that over 10% of the population benefit from the care of an accredited practice. The cost of the accreditation procedure relates to the number of patients in the practice and is about 6000 Euro per practice. 108 This is partly refunded by an increase of about one euro of the capitation fee. The incentive for the GPs is a quality label. Accreditation also results in points for mandatory re-certification (which is due every 5 years). Other incentives are the enthusiasm created within the team, better working relations and good public relations with patients and stakeholders. 108 The indicators used are detailed in the appendix 6. The indicators cover e.g. all indicators used in the European Practice Assessment programme. 2.4.3.3 Evidence for effectiveness Van den Hombergh and other authors concluded that the accreditation system based on indicators of organisation of a practice is feasible in the Dutch context. 109-111, 40 The practice visit method was effective in a controlled study comparing two strategies of intervention (mutual visits and visits by a non-physician professional). The clinical indicators were not part of the initial work of van den Homberg. They have been introduced using the work of Campbell et al. 112
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 35 and 36: 21 Quality development in general p
Page 41: KCE Reports 76 Quality development
Page 53 and 54: KCE Reports Quality development in
Page 93 and 94:
KCE Reports 76 Quality development
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?