status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 79
APPENDIX 4: SELECTED REVIEWS
Author Research question Method Results Information/country Remarks for Belgium
Grimshaw JM
2004{Grimshaw,
2004 #108}
Rhydderch M
2005{Rhydderch,
2005 #53}
Contencin P
2006{Contencin,
2006 #63}
To undertake a
systematic review of
effectiveness and costs
of different guideline
development,
dissemination and
implementation
strategies
To inform the debate by
reviewing the
international peerreviewed
literature on
organizational
assessments used in
general practice settings
To review
performance
assessment methods
used in general
practice
Systematic review
1966-1998
All clinical guidelines
including general
practice and hospital
settings
Systematic review
1996-2003
Systematic review
up to 2004.
Key informants
were used per
country.
Studies on cost-effectiveness are
scarce. Multifaceted interventions,
i.e. encompassing practice visits or
written materials do not seem to be
more effective than simple
interventions
Thirteen papers including 5
assessment instruments were
included for appraisal
The focus is on Europe - which
countries use which methods -
and on the following aspects:
which authorities or bodies are
responsible for setting up and
running the systems, are the
systems mandatory or
voluntary, who takes part in
assessments and what is their
motivation, are patients views
taken into account.
Dominated by studies in the
USA and UK
Generic. USA (3), Netherlands (1),
Australia (1)
UK: negotiated a GMS contract
for provision of care under the
NHS whereby up to a third of
a practice’s income cab depend
on performance as judged by
score points for quality
indicators.
France: The ANAES was
commissioned to design a
national system for voluntary
performance assessment of
Guideline development and
implementation does not seem
to be very efficient. Simple
dissemination may be most
cost-effective
The authors differentiate
between external led approach
(professional led, external
assessment, benchmarked)
versus internal development.
They suggest an incremental
level (Australia);
Minimal standards, demonstrate
excellence on these minimal
standard (VIP, Netherlands),
growing towards higher
standards hence growing
towards an organisational
culture along philosophies of the
primary care system (i.e.
community focus, continuity of
care)
A potentially successful
assessment method in any
country has to be in line
with:
• Prevailing healthcare
management and
regulation
• Cultural factors
• Patients’
expectations
A key factor seems to be