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Measurement of Quality Improvement in Family Practice over Two-year Period Using Electronic Database Quality Indicators: Retrospective Cohort Study from Israel
Shlomo Vinker
; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Alex Lustman
; Department of Family Medicine, Central District, Clalit Health Services, Rishon LeZion, Israel
Asher Elhayany
; Central District, Clalit Health Services, Rishon LeZion, Israel
Sažetak
Aim To investigate the associations between family physicians’
characteristics and the change in quality of health
care indicators (QI) over a two-year period.
Methods The retrospective cohort study included 161
(60.5%) of 266 family physicians who worked for the Clalit
health fund in Israel in the period from January 2003 until
December 2005. Family physicians’ background characteristics
included seniority, location of the clinic (urban or rural),
workload, sex, managerial responsibilities, and board
certification. The performance in 11 QIs, including indicators
of diabetes follow-up (n = 4) and control (n = 2), hospitalization
for chronic obstructive pulmonary disease and
congestive heart failure (n = 2), and preventive medicine
measures (influenza immunization for high risk patients
and mammography) was evaluated at the end of 2003 and
2005.
Results There was an improvement in all the QIs except
mammography. The improvement was significant for 8/10
QIs, the greatest being in achieving low-density lipoprotein
cholesterol (+18.2%) and HbA1c (+5.9%) targets in diabetic
patients. Multivariate regression model showed that
the most significant factor associated with better QIs in December
2003 was board certification, while 2 years later it
was female sex and having a managerial position. Being
a board-certified physician remained positively associated
with high QIs for diabetes control.
Conclusion There was an improvement in most QIs in the
period of 2 years. Initially, board certification was significantly
associated with high QIs, but clinic managers and female
physicians showed the ability to improve their scores.
Research should continue to find ways to make all physicians
responsive to their QIs.
Ključne riječi
Primary care physician; healthcare quality indicator; preventive medicine
Hrčak ID:
47859
URI
Datum izdavanja:
15.8.2009.
Posjeta: 1.303 *