Abstract
BackgroundThe level of quality of care of ambulatory services in Switzerland is almost completely unknown. By adapting existing instruments to the Swiss national context, the present project aimed to define quality indicators (QI) for the measurement of quality of primary care for use on health insurance claims data. These data are pre-existing and available nationwide which provides an excellent opportunity for their use in the context of health care quality assurance.MethodsPragmatic 6-step process based on informal consensus. Potential QI consisted of recommendations extracted from internationally accepted medical practice guidelines and pre-existing QI for primary care. An independent interdisciplinary group of experts rated potential QI based on explicit criteria related to evidence, relevance for Swiss public health, and controllability in the Swiss primary care context. Feasibility of a preliminary set of QI was tested using claims data of persons with basic mandatory health insurance with insurance at one of the largest Swiss health insurers. This test built the basis for expert consensus on the final set of QI.ResultsOf 49 potential indicators, 23 were selected for feasibility testing based on claims data. The expert group consented a final set of 24 QI covering the domains general aspects/ efficiency (7 QI), drug safety (2), geriatric care (4), respiratory disease (2), diabetes (5) and cardiovascular disease (4).ConclusionsThe present project provides the first nationwide applicable explicit evidence-based criteria to measure quality of care of ambulatory primary care in Switzerland. The set intends to increase transparency related to quality and variance of care in Switzerland.
Highlights
The level of quality of care of ambulatory services in Switzerland is almost completely unknown
A list of 49 potential quality indicators (QI) was sent to the expert group for rating of relevance for public health, clarity of definition, influence on measured aspect of care, risk of undesired effects, and strength of evidence
Reasons for exclusion were the indicator not being influenceable by primary health care providers, being irrelevant for Swiss primary healthcare due to medical practice, medication market or patient population, or the indicator not being calculable due to lack of clinical information in health insurance claims data
Summary
The level of quality of care of ambulatory services in Switzerland is almost completely unknown. A broad spectrum of initiatives aim to increase the quality of primary care in Switzerland [1,2,3] These initiatives include a variety of different approaches such as certification measures [4,5,6], in-house medical guideline development or quality circles [7] that vary in terms of regional spread, objectives, target population, and evidence basis. Despite this wide range of projects, the level of quality of care of ambulatory services in Switzerland is almost completely unknown [8]. The topic of developing defined and feasible approaches for national quality assurance in ambulatory care are of great political and practical relevance
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