title: Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study.
abstract: OBJECTIVE
  To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland.
  
  
  METHODS
  Longitudinal study with three points of measurement.
  
  
  METHODS
  Primary care practices in Switzerland.
  
  
  METHODS
  In total, 45 of 91 primary care practices completed European Practice Assessment three times.
  
  
  RESULTS
  The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time.
  
  
  RESULTS
  Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01).
  
  
  CONCLUSIONS
  The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care.
authors.affiliation: Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Goetz
authors.affiliation: EQUAM-Stiftung, Bern, Switzerland.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Hess
authors.affiliation: EQUAM-Stiftung, Bern, Switzerland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Jossen
authors.affiliation: mediX Gruppenpraxis, Zürich, Switzerland.
authors.forename: Felix
authors.initials: F
authors.lastname: Huber
authors.affiliation: Institute of General Practice and Health Services Research, University of Zürich, Zürich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: AQUA-Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Brodowski
authors.affiliation: Swisspep Institut für Qualität und Forschung im Gesundheitswesen, Bern, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Künzi
authors.affiliation: Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany AQUA-Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D008137:Longitudinal Studies; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D013557:Switzerland