Prang Khic-Houy, Canaway Rachel, Bismark Marie, Dunt David, Kelaher Margaret
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
BMC Fam Pract. 2018 Feb 12;19(1):29. doi: 10.1186/s12875-018-0719-4.
Public performance reporting (PPR) of hospital data aims to improve quality of care in hospitals and to inform consumer choice. In Australia, general practitioners (GPs) are gatekeepers to secondary care with patients requiring their referral for non-emergency access. Despite their intermediary role, GPs have been generally overlooked as potential users of PPR of hospital data, with the majority of the PPR research focussing on consumers, surgeons and hospitals.
We examined the use of PPR of hospital data by GPs when referring patients to hospitals. Semi-structured interviews were conducted with 40 GPs, recruited via the Victorian Primary Care Practice-Based Research Network and GP teaching practices in Victoria, Australia. The interviews were recorded, transcribed and analysed thematically.
We found that the majority of GPs did not use PPR when referring patients to hospitals. Instead, they relied mostly on informal sources of information such as their own or patients' previous experiences. Barriers that prevented GPs' use of PPR in their decision making included: lack of awareness and accessibility; perceived lack of data credibility; restrictive geographical catchments for certain hospitals; limited choices of public hospitals in regional and rural areas; and no mandatory PPR for private hospitals.
Our findings suggest that lack of PPR awareness prevented GPs from using it in their referral practice. As gatekeepers to secondary care, GPs are in a position to guide patients in their treatment decisions and referrals using available PPR data. We suggest that there needs to be greater involvement by GPs in the development of hospital performance and quality indicators in Australia if GPs are to make greater use of them. The indicators require further development before GPs perceive them as valid, credible, and of use for informing their referral practices.
医院数据的公开绩效报告（PPR）旨在提高医院的医疗质量并为消费者的选择提供信息。在澳大利亚，全科医生（GPs）是二级医疗的守门人，患者非紧急情况下需要他们转诊才能获得医疗服务。尽管全科医生具有中间人的角色，但他们作为医院数据PPR潜在使用者的身份却普遍被忽视，大多数PPR研究都集中在消费者、外科医生和医院身上。
我们研究了全科医生在将患者转诊至医院时对医院数据PPR的使用情况。通过澳大利亚维多利亚州基于初级医疗实践的研究网络和维多利亚州的全科医生教学实践招募了40名全科医生，并对他们进行了半结构化访谈。访谈进行了录音、转录并进行了主题分析。
我们发现，大多数全科医生在将患者转诊至医院时并不使用PPR。相反，他们主要依赖非正式信息来源，如他们自己或患者以前的经验。阻碍全科医生在决策中使用PPR的障碍包括：缺乏认识和获取渠道；认为数据缺乏可信度；某些医院的地理服务范围有限；地区和农村地区公立医院选择有限；私立医院没有强制性的PPR。
我们的研究结果表明，缺乏对PPR的认识阻碍了全科医生在转诊实践中使用它。作为二级医疗的守门人，全科医生有能力利用现有的PPR数据指导患者做出治疗决策和转诊。我们建议，如果全科医生要更多地使用这些指标，澳大利亚的全科医生需要更多地参与医院绩效和质量指标的制定。在全科医生认为这些指标有效、可信并可用于指导他们的转诊实践之前，这些指标还需要进一步完善。
