Szecsenyi Joachim, Broge Björn, Willms Sara, Brodowski Marc, Götz Katja
Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg.
Z Evid Fortbild Qual Gesundhwes. 2011;105(5):404-7. doi: 10.1016/j.zefq.2011.05.007. Epub 2011 Jun 16.
The European Practice Assessment (EPA) is a comprehensive quality management which consists of 220 indicators covering 5 domains (infrastructure, people, information, finance, and quality and safety). The aim of the project presented was to evaluate EPA as an instrument for benchmarking in ambulatory care practices. A before-and-after design with a comparison group was chosen. One hundred and two practices conducted EPA at baseline (t1) and at the 3-year follow-up (t2). A further 209 practices began EPA at t2 (comparison group). Since both practice groups differed in several variables (age of GP, location and size of practice), a matched-pair design based on propensity scores was applied leading to a subgroup of 102 comparable practices (out of the 209 practices). Data analysis was carried out using Z scores of the EPA domains. The results showed significant improvements in all domains between t1 and t2 as well as between the comparison group and t2. Furthermore, the results demonstrate that the implementation of total quality management and the re-assessment of the EPA procedure can lead to significant improvements in almost all domains.
欧洲实践评估（EPA）是一项全面质量管理，由涵盖5个领域（基础设施、人员、信息、财务以及质量与安全）的220项指标组成。所呈现项目的目的是评估EPA作为门诊医疗实践基准工具的情况。采用了带有对照组的前后设计。102家医疗机构在基线期（t1）和3年随访期（t2）进行了EPA评估。另外209家医疗机构在t2期开始进行EPA评估（对照组）。由于两个医疗机构组在几个变量（全科医生年龄、医疗机构位置和规模）上存在差异，因此采用了基于倾向得分的配对设计，从而从209家医疗机构中得出了102家具有可比性的医疗机构子组。使用EPA各领域的Z分数进行数据分析。结果显示，在t1和t2之间以及对照组和t2之间，所有领域均有显著改善。此外，结果表明，全面质量管理的实施以及EPA程序的重新评估几乎可以在所有领域带来显著改善。
