Abstract
Introduction: To the best of our knowledge, no quality indicators (QIs) for primary care provided by local clinics have yet been developed in Japan. We aimed to develop valid and applicable QIs to evaluate primary care in Japan. Methods: Two focus group interviews were held to identify conceptual categories. Existing indicators for these categories were identified, and initial sets of potential QIs were developed. Using a modified Delphi appropriateness method, a multidisciplinary expert panel then developed and selected the QIs. Feasibility and applicability of these QIs were then confirmed in pilot testing at six local clinics in Hokkaido, Japan. To determine patient acceptance of these quality improvement activities, the survey asked two questions, “Do you think it is preferable that the patients of this clinic be periodically surveyed?” and “Do you think it is preferable that this clinic periodically undergo an external quality review by an independent body?” Results: Seven categories emerged from the focus group discussions as key components of primary care in Japan. Thirty-nine QIs under five categories (Comprehensive care/Standardized care, Access, Communication, Co-ordination, and Understanding of patient background) were finally selected and named the QIs for Primary Care Practice in Japan. In pilot testing at six primary care clinics in 2015, 65.4% of patients answered favorably to the idea that clinics should conduct regular patient surveys, and 71.8% answered favorably to the idea that clinics should undergo periodic external quality review by an independent body. Conclusions: We developed QIs to assess primary care services provided by clinics in Japan, for the first time. Although further refinement is required, establishment of these QIs is the first step in quality improvement for primary care practices in Japan.
Highlights
IF an outpatient, person age 75 or older is started on a new prescription medication, and he or she has a followup visit with the prescribing physician, the medical record at the follow-up visit should document one of the following: the medication is being taken, the physician asked about the medication, or the medication was not started because it was not needed or because it was changed
IF a person age 75 or older is newly diagnosed with heart failure, he or she should undergo the following studies within 1 month of the diagnosis: chest x-ray, electrocardiogram, CBC, serum sodium and potassium, serum creatinine, and TSH in patients with atrial fibrillation or heart failure with no obvious etiology
IF a person age 75 or older is newly diagnosed with heart failure, he or she should be offered an evaluation of left ventricular ejection fraction within 1 month
Summary
IF a person age 75 or older is discharged from a hospital to home, and he or she received a new prescription medication or a change in medication prior to discharge, the outpatient medical record should document or acknowledge the medication change within 6 weeks of discharge. IF a person age 75 or older is discharged from a hospital to home or to a nursing home, and the hospital medical record specifies a follow-up appointment for a physician visit or a Related Quality Indicators for CONTINUITY AND COORDINATION OF CARE. IF a person age 75 or older with dementia is to be physically restrained in the hospital, the target behavioral disturbance or safety issue justifying use of restraints must be identified to the consenting person (patient or legal guardian) and documented in the chart
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