Swiss Quality and Outcomes Framework: Quality Indicators for Diabetes Management in Swiss Primary Care Based on Electronic Medical Records

Abstract

Background: Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. Objective: We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). Methods: We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. Results: A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. Conclusions: Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.

General Practitioners’ vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension – a cross-sectional database study

“…In fact, the prevalence of patients with diabetes was approximately 15 % in our study population and therefore in the expected range considering age and morbidity [ 14 ]. Moreover, previous studies have shown that the majority of patients with diabetes in Swiss primary care undergo regular BP measurement [ 15 ]. Apparently, GPs are aware of the necessity of BP control in patients with diabetes.…”

Pay-for-performance in resource-constrained settings: Lessons learned from Thailand’s Quality and Outcomes Framework

“…One example of an unsuccessful introduction of computerised information systems in Thailand is the abandoned Telemedicine Network launched in 1998; it failed because of the lack of IT skills among health professionals, the low level of system acceptance among users, and the rapid changes in the IT system 12, 13 . In addition, a study on the QOF in Switzerland 14 revealed that an incomplete database was unable to reflect the quality of healthcare delivery. Furthermore, different studies suggest that healthcare workers should be able to perform proper data entry, and these data should be used as feedback for improving the quality of healthcare delivery [14][15][16] .…”

“…In addition, a study on the QOF in Switzerland 14 revealed that an incomplete database was unable to reflect the quality of healthcare delivery. Furthermore, different studies suggest that healthcare workers should be able to perform proper data entry, and these data should be used as feedback for improving the quality of healthcare delivery [14][15][16] .…”

Editorial: Quality of Life in Multimorbidity

“…Using diabetes type 1 and 2 as an exemplary chronic illness condition, Djalali et al [[7], this issue] introduce a feasibility study on the development of a novel quality and outcomes framework for Switzerland (SQOF) compared to a similar framework implemented in Great Britain. The SQOF is based on available electronic medical records from general practitioners and aims at narrowing the evidence-performance gap identified in clinical settings for vulnerable patients such as those suffering from multiple chronic conditions.…”