status quo of quo vadis? - KCE
status quo of quo vadis? - KCE status quo of quo vadis? - KCE
60 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 The GPs trust those parties and that trust is crucial to ensure the validity of the data collected. In Australia, the professional bodies initiated third parties that receive financial means from the government: they are responsible for creating the IT platforms and coaching practices. In the Netherlands, a national organisation run by the GP’s association is the dedicated third party. The independent trustworthy body can address many tasks. • They implement the procedures to collect and analyse the data using IT platforms: repetitive measurements are necessary to assess and further improve the level of quality; • They provide data handling and feedback reports to the practices; • They offer coaching and support for the practices: feedbacks and coaching of the practices are crucial for a successful quality cycle: they support the formative processes and reinforce learning activities. • They may issue accreditation certificates when targets for indicators are reached (and eventually calculate the ‘fee for performance’); They communicate aggregated and anonymous data to the Health Authorities, anonymous data for research purposes and aggregated data to the Glems/LOKs in order to promote quality activities in the peer review groups. In Belgium, a trustworthy independent body could be initiated in collaboration with the scientific professional bodies and/or with regional organisations of GPs. As an illustration, some regions have successfully built partnerships and IT platforms to organise large scale after-hours services 145 . They have an expertise in the management of information technology and feedback. They could for example play a role in the data collection and feedback to the practices. The composition of this independent body is a major point of discussion that should be handled by the stakeholders mentioned in the point 4.3.1. 4.3.10 Financial support The Belgian Health Authorities have an interest in initiatives for improving quality of care. In general practice, the Authorities invested in the initiatives described above i.e., ‘accreditation’, feedback and GLEMs/LOKs (see chapter 4.1). The sum invested in the accreditation procedure is estimated to be at least 73 791 271 euros with few evaluation of the impact on the quality of care. There is still a lot of work to be done for quality improvement in Belgian general practice and that needs financial support. The Authorities also recently provided a lump sum of 6 800 000 euros specifically for quality development initiatives in hospitals, showing ongoing interest for quality 146 . New quality initiatives need preliminary pilot tests before any further investment. As a comparison, pilot experiences also preceded the implementation of large scale afterhours care services. 145 The financial support of the GP practice should consider the investment for participating in quality initiatives and the results of the assessment. First, the work relating to the process should be rewarded (e.g., introduction to quality concepts and quality work, data entering, working on the quality cycle with a tutor). Secondly, complementary fees could be an incentive for reaching targets for quality indicators. As stated above, the development of a balanced set of indicators that mirrors the scope of general practice is important (e.g., preventive tasks, patient satisfaction and clinical indicators for chronic diseases). The UK experience shows that risks are linked with target payment including a less holistic approach, a possible patient selection and a focus on well-paid activities to the detriment of less measurable quality items. The interpretation of the measurement has to take into account specific contextual factors like working in deprived areas.
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 61 10 elements to consider in the development of a quality framework • The need for a professional GP culture oriented towards quality; • The major role of the health authorities in particular for the development of a quality policy, the definition of health objectives, the legislation, the creation and support of an independent trustworthy body, the standardisation of the IT system and the necessary funding; • The involvement of all stakeholders; • The scientific input from GP scientific bodies and GP academic departments e.g. for defining quality initiatives and developing sets of indicators; • The development of valid clinical and non clinical indicators covering the broad scope of general practice; • The definition of an optimal balance between internal and external drivers for GPs to develop quality initiatives in their practice; • An emphasis on the practice of the GPs; • The improvement of the organisation of the GP practice in terms of personnel and IT infrastructure; • The importance of an independent trustworthy body that will be the major interface for the analysis and feedback of data to the GPs and other stakeholders; • The availability of financial support that takes into account the structure needed for the collection of data, the production of the tools selected for developing quality and the incentives for the GPs.
- Page 23 and 24: KCE Reports 76 Quality development
- Page 25 and 26: KCE Reports 76 Quality development
- Page 27 and 28: KCE Reports 76 Quality development
- Page 29 and 30: KCE Reports 76 Quality development
- Page 31 and 32: KCE Reports 76 Quality development
- Page 33 and 34: KCE Reports 76 Quality development
- Page 35 and 36: 21 Quality development in general p
- Page 37 and 38: KCE Reports 76 Quality development
- Page 39 and 40: KCE Reports 76 Quality development
- Page 41 and 42: KCE Reports 76 Quality development
- Page 43 and 44: KCE Reports 76 Quality development
- Page 45 and 46: KCE Reports 76 Quality development
- Page 47 and 48: KCE Reports 76 Quality development
- Page 49 and 50: KCE Reports 76 Quality development
- Page 51 and 52: KCE Reports 76 Quality development
- Page 53 and 54: KCE Reports Quality development in
- Page 55 and 56: KCE Reports 76 Quality development
- Page 57 and 58: KCE Reports 76 Quality development
- Page 59 and 60: KCE Reports 76 Quality development
- Page 61 and 62: KCE Reports 76 Quality development
- Page 63 and 64: KCE Reports 76 Quality development
- Page 65 and 66: KCE Reports 76 Quality development
- Page 67 and 68: KCE Reports 76 Quality development
- Page 69 and 70: KCE Reports 76 Quality development
- Page 71 and 72: KCE Reports 76 Quality development
- Page 73: KCE Reports 76 Quality development
- Page 77 and 78: KCE Reports 76 Quality development
- Page 79 and 80: KCE Reports 76 Quality development
- Page 81 and 82: KCE Reports 76 Quality development
- Page 83 and 84: KCE Reports 76 Quality development
- Page 85 and 86: KCE Reports 76 Quality development
- Page 87 and 88: KCE Reports 76 Quality development
- Page 89 and 90: KCE Reports 76 Quality development
- Page 91 and 92: KCE Reports 76 Quality development
- Page 93 and 94: KCE Reports 76 Quality development
- Page 95 and 96: KCE Reports 76 Quality development
- Page 97 and 98: KCE Reports 76 Quality development
- Page 99 and 100: KCE Reports 76 Quality development
- Page 101 and 102: KCE Reports 76 Quality development
- Page 103 and 104: KCE Reports 76 Quality development
- Page 105 and 106: KCE Reports 76 Quality development
- Page 107 and 108: KCE Reports 76 Quality development
- Page 109 and 110: KCE Reports 76 Quality development
- Page 111 and 112: KCE Reports 76 Quality development
- Page 113 and 114: KCE Reports 76 Quality development
- Page 115 and 116: KCE Reports 76 Quality development
- Page 117 and 118: KCE Reports 76 Quality development
- Page 119 and 120: KCE Reports 76 Quality development
- Page 121 and 122: KCE Reports 76 Quality development
- Page 123 and 124: KCE Reports 76 Quality development
<strong>KCE</strong> Reports 76 Quality development in general practice in Belgium: <strong>status</strong> <strong>quo</strong> or <strong>quo</strong> <strong>vadis</strong> ? 61<br />
10 elements to consider in the development <strong>of</strong> a quality framework<br />
• The need for a pr<strong>of</strong>essional GP culture oriented towards quality;<br />
• The major role <strong>of</strong> the health authorities in particular for the development<br />
<strong>of</strong> a quality policy, the definition <strong>of</strong> health objectives, the legislation, the<br />
creation and support <strong>of</strong> an independent trustworthy body, the<br />
standardisation <strong>of</strong> the IT system and the necessary funding;<br />
• The involvement <strong>of</strong> all stakeholders;<br />
• The scientific input from GP scientific bodies and GP academic<br />
departments e.g. for defining quality initiatives and developing sets <strong>of</strong><br />
indicators;<br />
• The development <strong>of</strong> valid clinical and non clinical indicators covering the<br />
broad scope <strong>of</strong> general practice;<br />
• The definition <strong>of</strong> an optimal balance between internal and external<br />
drivers for GPs to develop quality initiatives in their practice;<br />
• An emphasis on the practice <strong>of</strong> the GPs;<br />
• The improvement <strong>of</strong> the organisation <strong>of</strong> the GP practice in terms <strong>of</strong><br />
personnel and IT infrastructure;<br />
• The importance <strong>of</strong> an independent trustworthy body that will be the<br />
major interface for the analysis and feedback <strong>of</strong> data to the GPs and<br />
other stakeholders;<br />
• The availability <strong>of</strong> financial support that takes into account the structure<br />
needed for the collection <strong>of</strong> data, the production <strong>of</strong> the tools selected for<br />
developing quality and the incentives for the GPs.