title: Measures of quality, costs and equity in primary health care instruments developed to analyse and compare primary care in 35 countries.
abstract: BACKGROUND
  The Quality and Costs of Primary Care in Europe (QUALICOPC) study aims to analyse and compare how primary health care systems in 35 countries perform in terms of quality, costs and equity. This article answers the question 'How can the organisation and delivery of primary health care and its outcomes be measured through surveys of general practitioners (GPs) and patients?' It will also deal with the process of pooling questions and the subsequent development and application of exclusion criteria to arrive at a set of appropriate questions for a broad international comparative study.
  
  
  METHODS
  The development of the questionnaires consisted of four phases: a search for existing validated questionnaires, the classification and selection of relevant questions, shortening of the questionnaires in three consensus rounds and the pilot survey. Consensus was reached on the basis of exclusion criteria (e.g. the applicability for international comparison). Based on the pilot survey, comprehensibility increased and the number of questions was further restricted, as the questionnaires were too long.
  
  
  RESULTS
  Four questionnaires were developed: one for GPs, one for patients about their experiences with their GP, another for patients about what they consider important, and a practice questionnaire. The GP questionnaire mainly focused on the structural aspects (e.g. economic conditions) and care processes (e.g. comprehensiveness of services of primary care). The patient experiences questionnaire focused on the care processes and outcomes (e.g. how do patients experience access to care?). The questionnaire about what patients consider important was complementary to the experiences questionnaire, as it enabled weighing the answers from the latter. Finally, the practice questionnaire included questions on practice characteristics.
  
  
  CONCLUSIONS
  The QUALICOPC researchers have developed four questionnaires to characterise the organisation and delivery of primary health care and to compare and analyse the outcomes. Data collected with these instruments will allow us not only to show in detail the variation in process and outcomes of primary health care, but also to explain the differences from features of the (primary) health care system.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. w.schafer@nivel.nl
authors.forename: Willemijn L A
authors.initials: WL
authors.lastname: Schäfer
authors.forename: Wienke G W
authors.initials: WG
authors.lastname: Boerma
authors.forename: Dionne S
authors.initials: DS
authors.lastname: Kringos
authors.forename: Evelyne
authors.initials: E
authors.lastname: De Ryck
authors.forename: Stefan
authors.initials: S
authors.lastname: Greß
authors.forename: Stephanie
authors.initials: S
authors.lastname: Heinemann
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Murante
authors.forename: Danica
authors.initials: D
authors.lastname: Rotar-Pavlic
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Chiara
authors.initials: C
authors.lastname: Seghieri
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Van den Berg
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.forename: Sara
authors.initials: S
authors.lastname: Willems
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
mesh_terms: D003431:Cross-Cultural Comparison; D005060:Europe; D017048:Health Care Costs; D019538:Health Care Surveys / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D006297:Health Services Accessibility; D006302:Health Services Research / Q000379:methods; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010358:Patient Participation; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires