[Consensus on a process of benchmarking in primary care in Barcelona]. / Consenso sobre un proceso de benchmarking en la atención primaria de salud de Barcelona.

OBJECTIVE: To define the strategy, the conceptual framework, the methodology and the indicators that are needed to promote and consolidate the culture of external reference (benchmarking) as a strategy for change in Primary Care teams (PCT). DESIGN: Cross-sectional, descriptive study. SETTING: Primary care services of the Barcelona City Health Region. METHOD: Two stages were distinguished. At the first stage, an adviser group was set up. This was divided into 4 focus groups in which the main lines, the conceptual framework, the sizes, the indicators and the methodology for comparing PCTs were agreed. The second stage, that of prioritization, was conducted by means of a questionnaire to opinion-formers. For each of the indicators proposed, they appraised the degree of agreement, the suitability and relevance of indicators, the capacity of PC to modify results and the practicality of the information for composing the indicators. RESULTS: The involvement of professionals, their approach to improvement, and the transparency and dissemination of the evaluation were identified as strategic elements of benchmarking dynamics. In line with the basic principles of PC and the health system, 6 dimensions for evaluation were set: accessibility, effectiveness, capacity to resolve problems, longitudinality, cost-efficiency, and results. 43 of the 57 indicators prioritized gained the consensus of over 90% of the consultants. CONCLUSIONS: Evaluation as a useful tool for managing PC quality has to generate improvements or changes in PCTs. The involvement of professionals in the design and development of evaluation may help both its acceptance and the implementation of the changes arising from it. The indicators used and the effect of benchmarking policy on the results of PC service delivery require evaluation.

Consenso sobre un proceso de benchmarking en la atención primaria de salud de Barcelona / Consensus on a process of benchmarking in primary care in Barcelona

Objetivo. Definir la estrategia, el marco conceptual, la metodología y los indicadores que han de impulsar y consolidar la cultura de la referencia externa (benchmarking) como estrategia de cambio en los equipos de atención primaria (EAP). Diseño. Estudio descriptivo, transversal. Emplazamiento. Servicios de atención primaria (AP) de la Región Sanitaria de la ciudad de Barcelona. Método. Se distinguen 2 fases. En la primera se constituyó un grupo asesor (GA) que se organizó en 4 grupos focales, donde se acordaron los ejes, el marco conceptual, las dimensiones, los indicadores y la metodología para la comparación de los EAP. La segunda fase, de priorización, se realizó a través de una encuesta a líderes de opinión, quienes para cada uno de los indicadores propuestos valoraron el grado de acuerdo y la adecuación de los indicadores, su relevancia, la capacidad de la AP para modificar el resultado y la factibilidad de la información para su elaboración. Resultados. La implicación de los profesionales, la orientación hacia la mejora, la transparencia y la difusión de la evaluación fueron identificados como elementos estratégicos de la dinámica de benchmarking. De acuerdo con los principios básicos de la AP y del sistema sanitario, se concretaron 6 dimensiones de evaluación: accesibilidad, efectividad, capacidad resolutiva, longitudinalidad, relación coste eficiencia y resultados. En 43 de los 57 indicadores priorizados se obtuvo el consenso de más del 90% de los consultores. Conclusiones. La evaluación como instrumento útil para la gestión de la calidad de la AP ha de generar acciones de mejora o cambio en los EAP. La implicación de los profesionales en su diseño y desarrollo puede ayudar a su aceptabilidad y a la implementación de las acciones de cambio que se deriven. Es necesario evaluar los indicadores utilizados y analizar la influencia que ha tenido la política de benchmarking en los resultados de la prestación de los servicios de AP

Objective. To define the strategy, the conceptual framework, the methodology and the indicators that are needed to promote and consolidate the culture of external reference (benchmarking) as a strategy for change in Primary Care teams (PCT). Design. Cross-sectional, descriptive study. Setting. Primary care services of the Barcelona City Health Region. Method. Two stages were distinguished. At the first stage, an adviser group was set up. This was divided into 4 focus groups in which the main lines, the conceptual framework, the sizes, the indicators and the methodology for comparing PCTs were agreed. The second stage that of prioritisation, was conducted by means of a questionnaire to opinion-formers. For each of the indicators proposed, they appraised the degree of agreement, the suitability and relevance of indicators, the capacity of PC to modify results and the practicality of the information for composing the indicators. Results. The involvement of professionals, their approach to improvement, and the transparency and dissemination of the evaluation were identified as strategic elements of benchmarking dynamics. In line with the basic principles of PC and the health system, 6 dimensions for evaluation were set: accessibility, effectiveness, capacity to resolve problems, longitudinality, cost-efficiency, and results. 43 of the 57 indicators prioritised gained the consensus of over 90% of the consultants. Conclusions. Evaluation as a useful tool for managing PC quality has to generate improvements or changes in PCTs. The involvement of professionals in the design and development of evaluation may help both its acceptance and the implementation of the changes arising from it. The indicators used and the effect of benchmarking policy on the results of PC service delivery require evaluation