Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands
Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands
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DOI：
10.1136/qshc.2007.023226
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发表时间：
2008-08-01
影响因子：
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通讯作者：
Mackenbach, J. P.
中科院分区：
文献类型：
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作者：
van der Ploeg, E.;Depla, M. F. I. A.;Mackenbach, J. P.
背景：医疗质量的测量是质量改进的第一步。为了衡量医疗质量，需要一套质量指标。我们描述了适应一套系统开发的美国质量指标为弱势老年人在荷兰的医疗保健。我们还比较了美国和荷兰的设置，看看质量指标可以在国家之间转移，已经在英国的两项研究中所做的，与混合results.Method：108美国质量指标GP护理弱势长者，涵盖8个条件，由一个小组9个临床专家在荷兰进行了评估。使用了兰德/UCLA适当性方法的修改版本。小组成员收到了美国的文献综述，扩展与最近和荷兰的文献，总结每个质量indicators.Results的证据：72个指标（67%的美国集）是（几乎）相同的荷兰和美国集。在某些情况下，这个百分比要低得多。在营养不良方面，美国的指标中只有一半被列入荷兰的指标。对于抑郁症，许多指标被丢弃或以显着的方式改变，结果是在荷兰和美国设置的原始17个指标中只有5个（29%）是相同的。质量指标可以在国家之间转移，但要谨慎，因为在美国和欧洲之间转移指标的三项研究中，有两项研究中有33 - 44%的指标被丢弃。对于目前研究中的某些情况，这个百分比要高得多。关于营养不良，几乎没有任何证据，各套指标之间的差异可归因于各国专家意见的差异。对于抑郁症，在美国和荷兰，似乎不同的证据被认为是重要的，荷兰的知识体系在美国并不为人所知。
Background: Measurement of the quality of healthcare is a first step for quality improvement. To measure quality of healthcare, a set of quality indicators is needed. We describe the adaptation of a set of systematically developed US quality indicators for healthcare for vulnerable elders in The Netherlands. We also compare the US and the Dutch set to see if quality indicators can be transferred between countries, as has been done in two studies in the UK, with mixed results.Method: 108 US quality indicators on GP care for vulnerable elders, covering eight conditions, were assessed by a panel of nine clinical experts in The Netherlands. A modified version of the RAND/UCLA appropriateness method was used. The panel members received US literature reviews, extended with more recent and Dutch literature, summarising the evidence for each quality indicator.Results: 72 indicators (67% of US set) were (nearly) identical in the Dutch and US sets. For some conditions, this percentage was much lower. For undernutrition, only half of the US indicators were included in the Dutch set. For depression, many indicators were discarded or changed in a significant way, with the result that only five of the original 17 indicators (29%) are the same in the Dutch and the US set.Conclusions: Quality indicators can be transferred between countries, but with caution, because in two of the three studies on transferring indicators between the US and Europe, 33 - 44% of the indicators were discarded. For some conditions in the current study, this percentage is much higher. For undernutrition, there is hardly any evidence, and differences between the indicator sets can be attributed to differences in expert opinion between the countries. For depression, it seems that different evidence is considered important in the US and in The Netherlands, of which the Dutch body of knowledge is not known in the US.