title: Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries.
abstract: BACKGROUND
  With free movement of labour in Europe, European guidelines on cardiovascular care and the enlargement of the European Union to include countries with disparate health care systems, it is important to develop common quality standards for cardiovascular prevention and risk management across Europe.
  
  
  METHODS
  Panels from nine European countries (Austria, Belgium, Finland, France, Germany, Netherlands, Slovenia, United Kingdom and Switzerland) developed quality indicators for the prevention and management of cardiovascular disease in primary care. A two-stage modified Delphi process was used to identify indicators that were judged valid for necessary care.
  
  
  RESULTS
  Forty-four out of 202 indicators (22%) were rated as valid. These focused predominantly on secondary prevention and management of established cardiovascular disease and diabetes. Less agreement on indicators of preventive care or on indicators for the management of hypertension and hypercholesterolaemia in patients without established disease was observed. Although 85% of the 202 potential indicators assessed were rated valid by at least one panel, lack of consensus among panels meant that the set that could be agreed upon among all panels was much smaller.
  
  
  CONCLUSIONS
  Indicators for the management of established cardiovascular disease have been developed, which can be used to measure the quality of cardiovascular care across a wide range of countries. Less agreement on how the quality of preventive care should be assessed was observed, probably caused by differences in health systems, culture and attitudes to prevention.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Manchester, UK. stephen.campbell@manchester.ac.uk
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Campbell
authors.forename: Sabine
authors.initials: S
authors.lastname: Ludt
authors.forename: Jan
authors.initials: J
authors.lastname: Van Lieshout
authors.forename: Nicole
authors.initials: N
authors.lastname: Boffin
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Davorina
authors.initials: D
authors.lastname: Petek
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Martin O
authors.initials: MO
authors.lastname: Roland
mesh_terms: D002309:Cardiology / Q000458:organization & administration / Q000592:standards*; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000628:therapy*; D003697:Delphi Technique; D005060:Europe; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006801:Humans; D008019:Life Style; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000458:organization & administration / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards*; D015203:Reproducibility of Results