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

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4 EPA: Quality management in primary care The EPA instrument was developed in English and translated into relevant languages by at least two independent translators per country (an EPA partner in cooperation with an independent translator). The whole instrument was piloted in 3-5 practices per country in Autumn 2003. Minor modifications were made as a result of this pilot and then between January and June 2004, data were collected from over 270 practices across the nine European countries (about thirty practices per country). As we used data collected from practices who volunteered to take part, rather than from a randomly selected sample, it would be inappropriate to present comparative data in this report. What did we find? The data collected from this larger scale study was then examined to test the properties of each question. Sixty questions were excluded from our analysis because: • They were open to misinterpretation; • They were duplicates of other questions; • There was more than 5% missing data for self-completed questionnaires; • More than 95% of practices in all nine countries achieved the question, which meant it was not a useful discriminator between practices The remaining questions were analysed using factor analyses (this reduces the number of questions to a smaller set of indicators by allowing us to group related questions together) and reliability analysis (checking to ensure that each dimension contained the appropriate indicators). This process resulted in a set of 57 indicators, spread across the five areas of the practice management framework. Implications for policy and practice The EPA study has successfully developed and tested a novel and comprehensive instrument which can be used to compare the organisational elements of general practice care in different European countries. We think that the instrument is useful for both formative (as an educational tool to help practices identify areas for improvement) and summative (to judge how well a practice is doing, usually compared to other practices) purposes.
The challenges of undertaking a large scale international project such as this should not be underestimated. The participants from the different countries had a long track record of working successfully together and good will and commitment was required to overcome the significant challenges associated with different languages, understandings, cultures and health systems. Each country made an important contribution to the research process and to the final product and the participants gained new insights into their own health systems from discussions with others in the group and from examining the study findings. As far as the UK is concerned, its long established system of general practice, mature primary health care teams and professionalized managerial processes contributed much to the project. In addition, the NPCRDC’s expertise in developing and using quality indicators was highly valued by the other partners. The future of EPA executive summary 35 The EPA instrument is not a finished product and requires further development and testing. The focus will be on three areas: 1. Updating the indicators as new evidence or experience comes on line; 2. Using the instrument in a representative sample of practices so that meaningful comparisons can be made between organizations and countries; 3. Examining ways of supporting practices which make use of the instrument in order to maximize its potential to improve the performance of primary care practices. 5
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(EPA): Quality management in primary care (Executive Summary 35)

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