status quo of quo vadis? - KCE

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