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.

[Comprehensive implementation of interprofessional quality circles regarding early prevention of childhood disadvantage in Baden Württemberg (Germany)]. / Flächendeckende Implementierung von hilfesystemübergreifenden Qualitätszirkeln zum Thema Frühe Hilfen in Baden-Württemberg.

BACKGROUND: The integration of available early interventions and healthcare for families with children by practicing pediatricians has yet to be systematically established. For this reason, the Association of Statutory Health Insurance Physicians of Baden-Wuerttemberg established overarching, accredited, cross-system quality circles that serve to integrate all representatives of the healthcare system as well as child and youth welfare services. These quality circles are led by specially trained moderator tandems consisting of pediatricians and staff members from youth welfare services. OBJECTIVES: The goal was to evaluate the endpoints of the regional implementation of cross-system quality circles for early interventions in the state of Baden-Wuerttemberg as well as the feasibility of establishing long-term training programs for cross-system moderator tandems. METHODS: This was a noncontrolled, longitudinal study to prepare a yearly evaluation of the quality-circle assessments as well as to gather statistics on the training of the moderator tandems within the Association of Statutory Health Insurance Physicians of Baden-Wuerttemberg. RESULTS: A total of 59 moderator tandems were trained in nine separate training sessions within the project period from 2011 to 2015. Overall, 33 quality circles were founded. In 2015, 566 persons were participating in the respective circles. Over the course of the study between 26 and 33 of the 44 urban and rural districts in the state of Baden-Wuerttemberg had at least one quality circle dedicated to early interventions. Ten further circles are presently in the process of being founded; 29 moderators have yet to commence their activity or have withdrawn from the program. DISCUSSION: Between 59 and 81 % of the urban and rural districts implemented cross-system quality circles. The training of the moderator tandems proceeded without complications. Because of the dropout quota of the trained moderator tandems, systematic and continual training of new tandems proves to be necessary.

The development of quality circles/peer review groups as a method of quality improvement in Europe. Results of a survey in 26 European countries.

BACKGROUND: Peer review groups (PRGs) and quality circles (QCs) commenced in The Netherlands and have grown to become an important method of quality improvement in primary care in several other European countries. OBJECTIVE: Our aim was to provide an overview of QC/PRG activities and exemplary programmes in European countries. METHODS: A survey was performed in three consecutive steps by EQuiP (European Working Party on Quality in Family Practice), which is a representative association of experts from 26 European countries. The national representatives initially completed a structured questionnaire documenting the number and objectives of QCs/PRGs, sources of support and special programmes in their countries (step 1). In step 2, these sources were used to extend and validate the expert statements. Step 3 studied paradigmatic initiatives in depth. RESULTS: Step 1 took place in 2000; the response rate was 100% (26 countries). QCs/PRGs were very active in 10 countries; 16 countries showed little or no activity. Participation ranged from <2 to 86% of all GPs. Step 2 concentrated upon the countries with a high level of activity. Development appeared to be associated with establishment in private practice and the portion of GPs with vocational training. Eight programmes from six countries describing the establishment and the targeting of QC/PRG work are presented as case reports (step 3). CONCLUSION: In the last 10 years, substantial development of QCs/PRGs has taken place in The Netherlands, the UK, Denmark, Belgium, Ireland, Sweden, Norway, Germany, Switzerland and Austria. Further evaluation is needed to clarify the impact on quality of care.

Quality circles in ambulatory care: state of development and future perspective in Germany.

OBJECTIVE: To survey the quantitative development of quality circles (peer review groups; QC) and their moderators in ambulatory care in Germany, to describe approaches to documentation and evaluation, to establish what types of facilities and support is available and to assess opinions on the future importance of QC. DESIGN: Cross-sectional survey using a standardized questionnaire and supplementary telephone interviews. SETTING: All 23 German regional Associations of Statutory Health Insurance Physicians (ASHIP) were surveyed. RESULTS: The total number of QC in ambulatory care in Germany increased rapidly from 16 in 1993 to 1633 in June 1996, with about 17% (range 1.0-52.1%) of all practicing physicians (112 158) currently involved. Throughout Germany, 2403 moderators were trained in 168 training courses by the qualifying date. Follow-up meetings were held or being planned in 20 ASHIP, with approximately 39% (23-95%) of the moderators participating. Systematic documentation of QC work was undertaken or planned in all 23 ASHIIP, and 10 ASHIP carried out comparative evaluation, with at least five others planning to start it. The ASHIP promoted the work of QC by providing organizational (22) or financial (20) support, materials (20) or mediation of resource persons (16). Eleven ASHIP received grants from drug companies. ASHIP rated the future importance of QC as increasing (18) or stable (four), but in no case as decreasing. CONCLUSIONS AND RECOMMENDATIONS: The quantitative growth of QC in Germany is encouraging, but the extent of support and evaluation appears insufficient. Increased methodological support and facilitation, follow-up meetings on a more regular basis, improved documentation and evaluation of individual QC, and problem oriented evaluation of their impact on health care are essential for further successful development. Principles, problems and solutions discussed may be relevant for similar QI activities in other countries.