title: Challenges of audit of care on clinical quality indicators for hypertension and type 2 diabetes across four European countries.
abstract: BACKGROUND
  The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain.
  
  
  METHODS
  Two common chronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records.
  
  
  RESULTS
  Although it was agreed to obtain the clinical indicators in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients' data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators.
  
  
  CONCLUSIONS
  Measurement of clinical performance in PC by audit is methodologically challenging: different databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured.
authors.affiliation: Department of Family Medicine, University of Tartu, Tartu, Estonia, kadri.suija@ut.ee.
authors.forename: Kadri
authors.initials: K
authors.lastname: Suija
authors.affiliation: Department of Family Medicine, University of Tartu, Tartu, Estonia.
authors.forename: Katrin
authors.initials: K
authors.lastname: Kivisto
authors.affiliation: Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sarria-Santamera
authors.affiliation: Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Simo
authors.initials: S
authors.lastname: Kokko
authors.affiliation: Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Ida
authors.initials: I
authors.lastname: Liseckiene
authors.affiliation: AG3 - Epidemiologie & International Public Health Fakultät für Gesundheitswissenschaften Universität Bielefeld, Bielefeld, Germany and.
authors.forename: Maren
authors.initials: M
authors.lastname: Bredehorst
authors.affiliation: Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Lina
authors.initials: L
authors.lastname: Jaruseviciene
authors.affiliation: National Institute of Primary Health Care, Budapest, Hungary.
authors.forename: Renata
authors.initials: R
authors.lastname: Papp
authors.affiliation: Department of Family Medicine, University of Tartu, Tartu, Estonia.
authors.forename: Marje
authors.initials: M
authors.lastname: Oona
authors.affiliation: Department of Family Medicine, University of Tartu, Tartu, Estonia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kalda
mesh_terms: D002908:Chronic Disease; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005060:Europe; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008485:Medical Audit; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D016896:Treatment Outcome
keywords: Diabetes mellitus; family practice; hypertension; medical records; primary health care; quality indicators.; type 2