Indicators

 

The EQuiP position paper on measuring quality in health care is a statement for all partners in health care on how patient data should be gathered and used for quality purposes. With this position paper, EQuiP wants to emphasise the ethical dimensions of patient data handling in quality measurement. This should, in all situations, guarantee patients’ privacy and confidentiality in the doctor-patient relationship.

This document, when referring to quality in health care, refers to the degree to which health care systems, services, and supplies for individuals and populations increase the likelihood for positive health outcomes and are consistent with current professional knowledge (IOM definition). When referring to quality measurement of health care, the document includes the collecting, storing and comparing of any data on health care performance and patient health.

Background
This group was created during the EQuiP meeting in Jerusalem in 2009. This was the first time that a group in EQuiP had been formed to discuss the topic of the indicators that can be used to measure the quality of the entire primary care consultation including the bio-psycho-social elements.

In a number of European countries indicators have been developed to measure the consultation, but almost all of these measurements relate to the purely biological part of the consultation (eg, diabetes control (HbA1C, LDL), blood pressure control, and appropriate medication in specific diseases) and do not measure the psycho-social part of the consultation.

While these biological indicators are important, the psycho-social part of the consultation is no less so, and can often be an important factor in improving the biological measurements in our patients. But how do we measure this part of the consultation? The group will attempt to develop indicators specifically for this purpose.

First of all we want to stress that biological indicators are important in themselves. We must continue to use these indicators in order to audit the medical management of diseases. It is also important to realise that different groups may wish to use these indicators for different purposes – administrators, government ministries for national statistics, scientific bodies, patient groups, and the doctors themselves to perform personal audits on their patients.

It is also important to define how the data that is collected will be used by the different bodies before embarking on the actual process of collection and to remember that all the indicators do not always measure quality of medical care.

In choosing indicators we must remember that the patients and their doctors are different and the illnesses themselves are different – acute versus chronic. Therefore, not all indicators can be used to make direct comparisons between doctors and the care that they provide.

Can a system be developed that can measure all the different aspects of the consultation – BIO-PSYCHO-SOCIAL? Perhaps some simple indicators can be chosen that can give some measure of the quality of the consultation:

  • The length of the consultation
  • Whether a medicine was prescribed for different complaints
  • Whether the patients left the consulting room “satisfied”

We still have not decided what these proxy indicators should be.
We decided on a number of areas that need to be developed :

  • Produce a policy paper on the subject.
  • Decide on appropriate indicators and develop them into a usable tool.
  • Make this tool available to members of EQuiP via the web site.