Ozaki Makiko, Matsumura Shinji, Iwamoto Momoko, Kamitani Satoshi, Higashi Takahiro, Toyama Manabu, Bito Seiji, Waza Kazuhiro
Internal Medicine Horikawa Hospital Kyoto Japan.
Division of Clinical Epidemiology National Hospital Organization Tokyo Medical left Tokyo Japan.
J Gen Fam Med. 2018 Dec 28;20(2):48-54. doi: 10.1002/jgf2.229. eCollection 2019 Mar.
Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan.
Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process-oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC-J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic.
A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%.
The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.
基层医疗质量指标（QIs）在全球范围内被广泛使用。然而，迄今为止，除了糖尿病护理外，日本尚未有关于使用QIs评估基层医疗质量的报道。在此，我们使用QIs评估日本当地诊所提供的基层医疗服务质量。
2015年，四家基层医疗诊所参与了回顾性病历审查。为了评估基层医疗质量，我们使用了日本基层医疗实践质量指标（QIPC-J）中的18个以过程为导向的QIs，这些指标是我们之前通过改良的德尔菲法制定的，该方法包含五个类别（综合护理/标准化护理、可及性、沟通、协调和对患者背景的了解）中的39个QIs。使用医疗报销数据从过去一年内在各诊所就诊的患者中选取成年受试者。我们通过审查病历收集数据，并计算每个QIs和诊所的质量得分。
共审查了4330份病历。总体质量得分为31.5%。对QIs的依从性范围为3.2%至85.6%。各诊所之间的一些质量得分差异很大，但诊所之间的总体护理质量差异较小，从29.2%至34.0%。
日本当地诊所提供的基层医疗服务质量因QIs和诊所而异。有必要采取提高护理质量的策略。
