Clinical governance as professional self-reflection: A cross-sectional study assessing the quality of COPD care in German general practice

Abstract

BACKGROUND In the United Kingdom, a system of clinical governance (CG) which was introduced “top-down” by politics tries to ensure high quality health services. In general practice, the meeting of quality targets was linked to financial incentives causing several negative effects. In Germany CG is not established. We advocate a “bottom-up” CG for German general practice to avoid these negative effects. AIMS To test “bottom-up” CG within a network of general practices (GPN) using chronic obstructive pulmonary disease (COPD) as example disease. As a first step, we wanted to assess the current care quality of the GPN for COPD. Furthermore, feasibility of a care quality assessment through routine data from electronic health records (EHR) should be evaluated. METHODS A cross-sectional study was conducted. Quality indicators (QI) were developed according to COPD guidelines. COPD patients of the GPN ≥40 years were identified. For the determination of QI, data were retrieved from EHR. RESULTS In total, 2568 COPD patients were identified. Their mean age was 67 (SD±12) years, 49% were male. Thirty-five percent had a parallel diagnosis of asthma. There was no documentation of any spirometry for 54% of patients, 29% had a spirometry within the previous year. An influenza vaccination was administered to 37% within the preceding twelve months, 12% received a pneumococcal vaccination in the last six years. Smoking status was documented for 44% within the last year. Several QI were not assessable. CONCLUSION Care quality assessment by means of EHR data was challenging due to non-standardized documentation. Assessable QI indicated suboptimal COPD care. Our results confirm the need for CG in German general practice and better EHR softwares supporting CG through structured documentation and feedback for GPs. We are planning to proceed with “bottom-up” CG by introducing quality improvement measures within the GPN in answer to this study.