Evaluating quality indicators for physical therapy in primary care.
OBJECTIVE
To evaluate measurement properties of a set of public quality indicators on physical therapy.


METHODS
An observational study with web-based collected survey data (2009 and 2010).


METHODS
Dutch primary care physical therapy practices.


METHODS
In 3743 physical therapy practices, 11 274 physical therapists reporting on 30 patients each.


METHODS
Eight quality indicators were constructed: screening and diagnostics (n= 2), setting target aim and subsequent of intervention (n = 2), administrating results (n = 1), global outcome measures (n = 2) and patient's treatment agreement (n = 1). Measurement properties on content and construct validity, reproducibility, floor and ceiling effects and interpretability of the indicators were assessed using comparative statistics and multilevel modeling.


RESULTS
Content validity was acceptable. Construct validity (using known group techniques) of two outcome indicators was acceptable; hypotheses on age, gender and chronic vs. acute care were confirmed. For the whole set of indicators reproducibility was approximated by correlation of 2009 and 2010 data and rated moderately positive (Spearman's ρ between 0.3 and 0.42 at practice level) and interpretability as acceptable, as distinguishing between patient groups was possible. Ceiling effects were assessed negative as they were high to extremely high (30% for outcome indicator 6-95% for administrating results).


CONCLUSIONS
Weaknesses in data collection should be dealt with to reduce bias and to reduce ceiling effects by randomly extracting data from electronic medical records. More specificity of the indicators seems to be needed, and can be reached by focusing on most prevalent conditions, thus increasing usability of the indicators to improve quality of care.
IQ Healthcare, University Medical Centre St. Radboud, PO Box 9101, 114, Nijmegen 6500 HB, The Netherlands IQ Healthcare, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.
Marijn
M
Scholte
Caransscoop, Beekbergen, The Netherlands Caransscoop, Saltshof 1229, Wijchen 6604 EC, The Netherlands.
Catharina W M
CW
Neeleman-van der Steen
Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands Faculty of Health, P. Debyeplein 1, Maastricht 6229 HA, The Netherlands.
Erik J M
EJ
Hendriks
IQ Healthcare, University Medical Centre St. Radboud, PO Box 9101, 114, Nijmegen 6500 HB, The Netherlands IQ Healthcare, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.
Maria W G
MW
Nijhuis-van der Sanden
IQ Healthcare, University Medical Centre St. Radboud, PO Box 9101, 114, Nijmegen 6500 HB, The Netherlands IQ Healthcare, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.
Jozé
J
Braspenning
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D026761:Physical Therapy Specialty / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012737:Sex Factors; D011795:Surveys and Questionnaires
measurement of quality; measurement properties; physical therapy; quality indicators