Schäfer Willemijn L A, Boerma Wienke G W, Kringos Dionne S, De Ryck Evelyne, Greß Stefan, Heinemann Stephanie, Murante Anna Maria, Rotar-Pavlic Danica, Schellevis François G, Seghieri Chiara, Van den Berg Michael J, Westert Gert P, Willems Sara, Groenewegen Peter P
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Qual Prim Care. 2013;21(2):67-79.
The Quality and Costs of Primary Care in Europe (QUALICOPC) study aims to analyse and compare how primary health care systems in 35 countries perform in terms of quality, costs and equity. This article answers the question 'How can the organisation and delivery of primary health care and its outcomes be measured through surveys of general practitioners (GPs) and patients?' It will also deal with the process of pooling questions and the subsequent development and application of exclusion criteria to arrive at a set of appropriate questions for a broad international comparative study.
The development of the questionnaires consisted of four phases: a search for existing validated questionnaires, the classification and selection of relevant questions, shortening of the questionnaires in three consensus rounds and the pilot survey. Consensus was reached on the basis of exclusion criteria (e.g. the applicability for international comparison). Based on the pilot survey, comprehensibility increased and the number of questions was further restricted, as the questionnaires were too long.
Four questionnaires were developed: one for GPs, one for patients about their experiences with their GP, another for patients about what they consider important, and a practice questionnaire. The GP questionnaire mainly focused on the structural aspects (e.g. economic conditions) and care processes (e.g. comprehensiveness of services of primary care). The patient experiences questionnaire focused on the care processes and outcomes (e.g. how do patients experience access to care?). The questionnaire about what patients consider important was complementary to the experiences questionnaire, as it enabled weighing the answers from the latter. Finally, the practice questionnaire included questions on practice characteristics.
The QUALICOPC researchers have developed four questionnaires to characterise the organisation and delivery of primary health care and to compare and analyse the outcomes. Data collected with these instruments will allow us not only to show in detail the variation in process and outcomes of primary health care, but also to explain the differences from features of the (primary) health care system.
欧洲初级保健的质量与成本（QUALICOPC）研究旨在分析和比较35个国家的初级卫生保健系统在质量、成本和公平性方面的表现。本文回答了“如何通过对全科医生（GP）和患者的调查来衡量初级卫生保健的组织与提供及其结果？”这一问题。它还将探讨汇总问题的过程以及随后制定和应用排除标准，以得出一套适用于广泛国际比较研究的合适问题。
问卷的制定包括四个阶段：搜索现有的经过验证的问卷、对相关问题进行分类和选择、通过三轮共识缩短问卷以及进行试点调查。基于排除标准（如国际比较的适用性）达成共识。根据试点调查，由于问卷过长，其可理解性提高，问题数量进一步受限。
制定了四份问卷：一份给全科医生，一份关于患者对其全科医生的体验，另一份关于患者认为重要的事项，还有一份实践问卷。全科医生问卷主要关注结构方面（如经济状况）和护理过程（如初级保健服务的全面性）。患者体验问卷关注护理过程和结果（如患者如何体验获得护理的机会？）。关于患者认为重要事项的问卷是对体验问卷的补充，因为它能够权衡后者的答案。最后，实践问卷包括关于实践特征的问题。
QUALICOPC研究人员开发了四份问卷来描述初级卫生保健的组织与提供情况，并比较和分析结果。用这些工具收集的数据不仅能让我们详细展示初级卫生保健过程和结果的差异，还能解释与（初级）卫生保健系统特征的差异。
