title: Process quality indicators in family medicine: results of an international comparison.
abstract: BACKGROUND
  The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care.
  
  
  METHODS
  The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level.
  
  
  RESULTS
  None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation.
  
  
  CONCLUSIONS
  A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians' characteristics.
authors.affiliation: Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia. danica.rotar@guest.arnes.si.
authors.forename: Danica Rotar
authors.initials: DR
authors.lastname: Pavlič
authors.affiliation: Statistical Office of the Republic of Slovenia, Litostrojska 54, 1000, Ljubljana, Slovenia. maja.sever1@gmail.com.
authors.forename: Maja
authors.initials: M
authors.lastname: Sever
authors.affiliation: Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia. zalika.klemenc.ketis@gmail.com.|Department of Family Medicine, Medical Faculty, University of Maribor, Taborska 8, 2000, Maribor, Slovenia. zalika.klemenc.ketis@gmail.com.
authors.forename: Zalika
authors.initials: Z
authors.lastname: Klemenc-Ketiš
authors.affiliation: Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia. igor.svab@mf.uni-lj.si.
authors.forename: Igor
authors.initials: I
authors.lastname: Švab
mesh_terms: D001315:Australia; D002170:Canada; D003266:Continuity of Patient Care / Q000592:standards; D005060:Europe; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D009520:New Zealand; D010821:Physicians, Family / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards; D011795:Surveys and Questionnaires