Measuring General Practice

The development and use of objective measures of the processes and outcomes of health care is fundamental to improving any health care system. Valid and reliable measures of quality serve to promote greater accountability of health professionals and organizations; act as a catalyst for quality improvement, as a vehicle for greater public and patient involvement; and provide an opportunity for patients and purchasers to exercise choice. For these reasons, general practice is starting to rise to the challenge to develop measures that reflect the values of the doctors and nurses working in primary care. This report summarizes a project that aimed to develop and test a comprehensive set of clinical quality indicators for use in British general practice. The study was commissioned by the Nuffield Trust with the aim of transferring expertise and specific measurement technologies from the United States to the UK. The project was conducted as a partnership between the National Primary Care Research and Development Centre, University of Manchester, UK, and The RAND Corporation, RAND Health, Santa Monica, California, USA. Expert panels rated 168 indicators for 19 targeted conditions, often seen in primary care practice, as valid measures of quality. The authors found that poor quality of data in general practice records, both in terms of its availability and accessibility, represents a significant obstacle to quality assessment in primary care. They also found that quality indicators, such as those developed in this project, have an important role to play in professionally led improvement, performance management, and user involvement. However, such a disease-focused approach to measuring quality in general practice will inevitably omit many important aspects of care, such as issues relating to access and interpersonal care. In addition, the tension between professionally led quality improvement and managerially led quality assessment needs to be recognized and addressed.