Quality assessment program in primary care clinics: a tool for quality improvement.
BACKGROUND
Assessment of quality of health care is a major ongoing project of the Israeli Defense Forces (IDF) medical corps.


OBJECTIVE
(i) To describe mechanisms of quality assessment (QA) in IDF primary care clinics; (ii) to compare quality of care in different types of primary care clinics; and (iii) to test the hypothesis that implementation of the QA program results in improved quality of care.


METHODS
A prospective, single-blinded, uncontrolled, non-randomized study.


METHODS
Teams of two physicians carry out the QA process once or twice a year according to clinic size. Five areas were evaluated: (i) physician-patient interaction; (ii) medical chart evaluation; (iii) high-risk patients management; (iv) medical care provided by specialists; and (v) medical staff guidance. Clinics were classified in two groups: single-physician clinics (battalion troop clinics) and multi-physician clinics (home-front base clinics). General Linear Models were used for analysis. A P-value <0.05 was considered significant.


RESULTS
In 2000 and 2001, 99 primary clinics and 162 primary care physicians were assessed. Seventy-four (45%) physicians were evaluated twice. Single-physician clinics scored higher than multi-physician clinics on most QA parameters. Physicians had significantly better QA results at the second encounter, regardless of the type of clinic.


CONCLUSIONS
A primary care medicine QA system is feasible in the IDF. It allows for standardized, reliable, and comprehensive assessment of primary care across the military clinics. We postulate that the increase in QA assessment scores from one examination to the next one indicates an improvement in quality due to the QA program.
Mandel
Dror
D
Medical Corps, Israel Defense Forces, Israel. mandelrd@netvision.net.il
Amital
Howard
H
Zimlichman
Eyal
E
Wartenfeld
Robert
R
Benyamini
Lilach
L
Shochat
Tzippora
T
Mimouni
Francis B
FB
Kreiss
Yitshak
Y
D000554:Ambulatory Care Facilities / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007557:Israel; D008887:Military Medicine; D011320:Primary Health Care / Q000592:standards*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*