van den Hombergh P, Grol R, van den Hoogen H J, van den Bosch W J
Centre for Quality of Care Research, University of Nijmegen, The Netherlands.
Br J Gen Pract. 1998 Nov;48(436):1743-50.
Practice management (PM) in general practice is as yet ill-defined; a systematic description of its domain, as well as a valid method to assess it, are necessary for research and assessment.
To develop and validate a method to assess PM of general practitioners (GPs) and practices.
Relevant and potentially discriminating indicators were selected from a systematic framework of 2410 elements of PM to be used in an assessment method (VIP = visit instrument PM). The method was first tested in a pilot study and, after revision, was evaluated in order to select discriminating indicators and to determine validity of dimensions (factor and reliability analysis, linear regression).
One hundred and ten GPs were assessed with the practice visit method using 249 indicators; 208 of these discriminated sufficiently at practice level or at GP level. Factor analysis resulted in 34 dimensions and in a taxonomy of PM. Dimensions and indicators showed marked variation between GPs and practices. Training practices scored higher on five dimensions; single-handed and dispensing practices scored lower on delegated tasks, but higher on accessibility and availability.
A visit method to assess PM has been developed and its validity studied systematically. The taxonomy and dimensions of PM were in line with other classifications. Selection of a balanced number of useful and relevant indicators was nevertheless difficult. The dimensions could discriminate between groups of GPs and practices, establishing the value of the method for assessment. The VIP method could be an important contribution to the introduction of continuous quality improvement in the profession.
全科医疗中的实践管理（PM）目前尚无明确界定；对其领域进行系统描述以及采用有效的评估方法，对于研究和评估而言是必要的。
开发并验证一种评估全科医生（GP）及其实践的实践管理的方法。
从包含2410个实践管理要素的系统框架中选取相关且具有潜在区分度的指标，用于一种评估方法（VIP = 就诊工具实践管理）。该方法首先在一项试点研究中进行测试，修订后进行评估，以选择具有区分度的指标并确定维度的有效性（因子分析和可靠性分析、线性回归）。
使用249个指标的实践就诊方法对110名全科医生进行了评估；其中208个指标在实践层面或全科医生层面具有足够的区分度。因子分析得出34个维度以及实践管理的分类法。维度和指标在全科医生和实践之间显示出显著差异。培训实践在五个维度上得分更高；个体经营和配药实践在委托任务方面得分较低，但在可及性和可用性方面得分较高。
已开发出一种评估实践管理的就诊方法，并对其有效性进行了系统研究。实践管理的分类法和维度与其他分类一致。然而，选择数量均衡的有用且相关的指标却很困难。这些维度能够区分不同组别的全科医生和实践，确立了该评估方法的价值。VIP方法可能对该行业引入持续质量改进做出重要贡献。
