(EPA): Quality management in primary care (Executive Summary 35)

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Countries taking part
esxecutive ummary
Nine European countries took part: Austria; Belgium; France; Germany; Israel;
Netherlands; Slovenia; Switzerland and the United Kingdom (represented by
NPCRDC for England and the Department of Primary Care, University of Wales
Swansea Clinical School for Wales). The research was co-ordinated by the Centre for
Quality of Care Research, WOK at the University of Nijmegen in the Netherlands,
funded by the participating countries and supported by the Bertelsmann Foundation
in Guttersloh, Germany (http://en.bertelsmann-stiftung.de/foundation_kp.html).
How we developed the indicators
In 2002 and 2003 EPA partners in the participating countries utilised expert panels to
develop a set of quality indicators representing primary care practice management.
We identified 171 potential indicators by undertaking a comprehensive review of the
published and grey literature. Grey literature is material which might not be formally
published, such as organizational reports. The findings were reviewed and refined at
a workshop for all participants in 2002. We then undertook a two-round postal Delphi
survey between June 2002 and January 2003 (Engels et al 2005). A Delphi survey is
designed to measure consensus among individual responses and normally consists
of a series of rounds where information is fed back to panel members using
questionnaires. It is the most commonly used method of developing quality indicators.
An expert panel was established in each country, consisting of ten people for each
panel, predominately general practitioners, but also practice managers in the UK and
NL. They were asked to rate all of the indicators for usefulness on a scale of 1 to 9,
with 1 being not useful at all and 9 being very useful. Analyses were based on the
Rand Appropriateness Method (Fitch et al 2001), in which indicators with an average
rating above 7 were considered valid for that panel/country, whereas those with a
national average of 1-3 were considered invalid. All other indicators were rated
equivocal. Only indicators that were rated valid by all six panels were included in the
European set of indicators. We looked at how many indicators were rated valid and
invalid by all countries and per country respectively.
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