Creation of a synthetic indicator of quality of care as a clinical management standard in primary care

Abstract

IntroductionThe development of electronic medical records has allowed the creation of new quality indicators in healthcare. Among them, synthetic indicators facilitate global interpretation of results and comparisons between professionals.MethodsA healthcare quality standard (EQA, the Catalan acronym for Estàndard de Qualitat Assistencial) was constructed to serve as a synthetic indicator to measure the quality of care provided by primary care professionals in Catalonia (Spain). The project phases were to establish the reference population; select health problems to be included; define, select and deliberate about subindicators; and construct and publish the EQA.ResultsConstruction of the EQA involved 107 healthcare professionals, and 91 health problems were included. In addition, 133 experts were consulted, who proposed a total of 339 indicators. After systematic paired comparison, 61 indicators were selected to create the synthetic indicator. The EQA is now calculated on a monthly basis for more than 8000 healthcare professionals using an automated process that extracts data from electronic medical records; results are published on a follow-up website. Along with the use of the online EQA results tool, there has been an ongoing improvement in most of the quality of care indicators.ConclusionsCreation of the EQA has proven to be useful for the measurement of the quality of care of primary care services. Also an improvement trend over 5 years is shown across most of the measured indicators.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-51) contains supplementary material, which is available to authorized users.

Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data

“…7 Overuse of resources may be considered as the converse of the traditional quality of care paradigm, which is largely about procedural omissions-quality is low when necessary care is not delivered. 11,12 In contrast, health care overuse is primarily a matter of commission where resources are used without sufficient likelihood of benefit. Examples include indexes measuring care in the neonatal intensive care unit, 8 in dialysis centers, 9 in surgery, 10 and in primary care.…”

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“…Access to the feedback screen is provided as a direct link within the electronic health record (Figs. 1, 2, in Catalan; an online demonstration of this feedback system is available at: http://www.amf-semfyc.com/sisap/) (Coma et al 2013). The monthly results are also used as part of a performance incentive variable in the compensation model; during the intervention year, the incentive will not exceed a total of 750 euros per physician and 380 euros per nurse.

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“…The feedback system also compiles a list of patients who do not meet all established criteria of the 62 evidence-based recommendations that constitute a unique index known as the Quality of Care Standard ( Estàndard de Qualitat Assistencial , EQA). At present, health professionals have point-of-care access to all of these results, with no additional data-recording effort on their part (Coma et al 2013). …”

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