Supplied by authors

Box 1: Examples of international methods for measuring healthcare performance and quality

Australia

� Doctors not participating in the general practice accreditation or not meeting the standards set by the profession lose income.

United States

� The Baldridge award, a voluntary scheme for assessing the quality of organisations in the US from many perspectives^w1 is yet to be won by a health care provider.

� The use of report cards and public disclosure of performance data has been well documented with results that are still argued about.^w2

Europe

� The EUROPEP instrument, measuring patients� evaluations of general practice, is widely used in Switzerland, Portugal and Denmark to assess practice performance.

� Practice visits are increasingly used in European countries to assess care provision in hospitals and primary care practices.^w3

� The Centre for Quality of Care Research (WOK) developed and is currently testing a set of 135 indicators derived from 60 national evidence based guidelines; they are meant to be used in continuous monitoring of primary care.

United Kingdom

� The National Primary Care Research and Development Centre has created 19 quality indicators specific for UK primary care.^w4

� The Royal College of General Practitioners� Fellowship by Assessment^w5 is set at a level to identify excellence.

� The General Medical Council�s proposed revalidation is calibrated for minimum standards.

� In the NHS, the service is assessed overall through the performance assessment framework.^w6 Using a set of centrally derived performance indicators each health care trust is measured, ranked and compared, the data feeding funding allocations and star ratings (first described as "traffic lights" in the NHS Plan).

� Assessments by the Commission for Health Improvement (to be part of the Commission for Healthcare Audit and Inspection) give detailed insights into the organisation of local services.^w7

� Organisations such as Dr Foster (http://home.drfoster.co.uk/) give public and professionals access to data derived from NHS sources or self-report.

Box 2: International perspectives on measuring improvement in care

In the Netherlands a representative group of over 100 primary care practices continuously monitors practice performance and receives feedback; data showed for instance an increase in flu vaccination in the population from 10 to 16 % and an increase in cervical smears in women at risk from about 45 to about 65% in the course of some years.³

The Northern New England Cardiovascular Disease Study Group used three components, including the feedback of outcome data, and were able to demonstrate a 24% reduction in in-hospital mortality (p<0.001).^w8

In England Primary Care Information Services (PRIMIS) has been commissioned to improve computer use and data quality in English general practice. It offers feedback to participating practices and primary care trusts on a range of clinical audit criteria and is demonstrating improvement in data quality.

References

w1 www.quality.nist.gov/ (accessed June 2002).

w2 Epstein A. Performance reports on quality�prototypes, problems, and prospects. N Engl J Med 1995;333;57-61.

w3 Van den Hombergh P, Grol R, van den Bosch W, van den Hoogen H. Assessment of management in general practice. Br J Gen Pract 1998;48:1743-50.

w4 Roland M, Holden J, Campbell S. Quality assessment for general practice. Manchester: National Primary Care Research and Development Centre, 1998.

w5 Royal College of General Practitioners. Fellowship by assessment. Occasional paper 50. Pringle M, ed. 2nd ed. London: RCGP, 1995.

w6 www.doh.gov.uk/piconsultation/ (accessed 15 August).

w7 Dobson R. Standards watchdog to get a bigger role in NHS. BMJ 2001;323:1145.

w8 Kasper JF, Plume SK, O�Connor GT. A methodology for QI in the coronary artery bypass grafting procedure involving comparative process analysis. Q Rev Bull 1992;18:129-33.