Wensing M, Grol R, van Montfort P, Smits A
Centre for Quality of Care Research, Universities of Nijmegen and Maastricht, The Netherlands.
Qual Health Care. 1996 Jun;5(2):73-80. doi: 10.1136/qshc.5.2.73.
To develop a list of indicators of the general practice care of people with chronic illnesses considered important by both patients and practitioners and to identify the indicators that are considered relevant for patient assessment of health care quality.
Qualitative study with focus group interviews and a written consensus procedure.
General practice in the Netherlands in 1993.
34 patients with chronic illness, mostly members of patient organisations, and 19 general practitioners with expertise in either chronic disease management or experience with patient surveys.
Aspects of general practice care considered important for the delivery of good quality care that emerged from focus group interviews; the relevance of evaluations of 41 aspects of care for patients explored through the written consensus procedure. Those aspects of general practice care agreed to be both important and relevant by patients and general practitioners were considered to be suitable indicators for patient assessment of the quality of care.
Patients and general practitioners differed to some extent in their assessment of the aspects of care that they considered important for quality. They agreed that most indicators of care that related to the ¿doctor-patient relation¿ and to ¿information and support¿ were relevant and therefore suitable as indicators for patient assessment of health care quality. There was less agreement about the relevance of indicators of ¿medical and technical care,¿ ¿availability and accessibility,¿ and ¿organisation of services.¿
Several indicators of the quality of general practice care of patients with chronic illness were thought to be suitable for the patient assessment of healthcare quality, but other indicators were not, mainly because of reservations by general practitioners.
Qualitative methods can contribute to the selection of indicators for assessment of the quality of health care in areas where scientific evidence is limited or where patients' and providers' preferences are particularly important.
制定一份慢性病患者全科医疗护理指标清单，这些指标需同时被患者和从业者视为重要指标，并确定那些被认为与患者对医疗质量评估相关的指标。
采用焦点小组访谈和书面共识程序的定性研究。
1993年荷兰的全科医疗。
34名慢性病患者，大多是患者组织成员，以及19名在慢性病管理方面有专业知识或有患者调查经验的全科医生。
焦点小组访谈中出现的被认为对提供高质量护理很重要的全科医疗护理方面；通过书面共识程序探讨的41个护理方面对患者评估的相关性。患者和全科医生都认为既重要又相关的那些全科医疗护理方面被视为患者评估护理质量的合适指标。
患者和全科医生在对他们认为对质量很重要的护理方面的评估上存在一定程度的差异。他们一致认为，大多数与“医患关系”和“信息与支持”相关的护理指标是相关的，因此适合作为患者评估医疗质量的指标。对于“医疗和技术护理”、“可及性和便利性”以及“服务组织”方面的指标的相关性，意见分歧较小。
一些慢性病患者全科医疗护理质量指标被认为适合患者评估医疗质量，但其他指标则不然，主要是因为全科医生有所保留。
在科学证据有限或患者和提供者的偏好特别重要的领域，定性方法有助于选择用于评估医疗质量的指标。
