Improving quality of care in general practices by self-audit, benchmarking and quality circles.
Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.
Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Universität Salzburg, Strubergasse 21, 5020, Salzburg, Austria. angelika.mahlknecht@pmu.ac.at.
Angelika
A
Mahlknecht
Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Auenbruggerplatz 2/9, 8036, Graz, Austria.|Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
Muna E
ME
Abuzahra
Südtiroler Akademie für Allgemeinmedizin, Wangergasse 18, 39100, Bolzano, Italy.
Giuliano
G
Piccoliori
Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Universität Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
Nina
N
Enthaler
Südtiroler Akademie für Allgemeinmedizin, Wangergasse 18, 39100, Bolzano, Italy.
Adolf
A
Engl
Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
Andreas
A
Sönnichsen
D000328:Adult; D001317:Austria / Q000453:epidemiology; D019985:Benchmarking / Q000592:standards / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000145:classification / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008332:Management Quality Circles / Q000592:standards / Q000706:statistics & numerical data*; D008485:Medical Audit / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
Chronic diseases; General practice; Healthcare quality; Quality circles; Quality indicators