Institute of Primary Care, University of Zurich and University Hospital Zurich, Zürich, Switzerland.
PLoS One. 2020 May 5;15(5):e0232686. doi: 10.1371/journal.pone.0232686. eCollection 2020.
Quality indicators and pay-for-performance schemes aim to improve processes and outcomes in clinical practice. However, general practitioner and patient characteristics influence quality indicator performance. In Switzerland, no data on the pay-for-performance approach exists and the use of quality indicators has been marginal. The aim of this study was to describe quality indicator performance in diabetes care in Swiss primary care and to analyze associations of practice, general practitioner and patient covariates with quality indicator performance.
For this cross-sectional study, we used medical routine data from an electronic medical record database. Data from 71 general practitioners and all their patients with diabetes were included. Starting in July 2018, we retrieved 12-month retrospective data about practice, general practitioner and patient characteristics, laboratory values, comorbidities and co-medication. Based on this data, we assessed quality indicator performance of process and intermediate outcomes for glycated hemoglobin, blood pressure, cholesterol and associations of practice, general practitioner and patient characteristics with individual and cumulative quality indicator performance. We calculated odds ratios (OR) and 95% confidence intervals (CI) using regression methods.
We assessed 3,383 patients with diabetes (57% male, mean age 68.3 years). On average, patients fulfilled 3.56 (standard deviation: 1.89) quality indicators, whereas 17.2% of the patients fulfilled all six quality indicators. On practice and general practitioner level, we found no associations with cumulative quality indicator performance. On patient level, gender (ref = male) (OR: 0.83, CI: 0.78-0.88), number of treating general practitioners (OR: 0.94, CI: 0.91-0.97), number of comorbidities (OR: 1.43, CI: 1.38-1.47) and number of consultations (OR: 1.02, CI: 1.02-1.02) were associated with cumulative quality indicator performance.
The influence of practice, general practitioner and patient characteristics on quality indicator performance was surprisingly small and room for improvement in quality indicator performance of Swiss general practitioners seems to exist in diabetes care.
质量指标和按绩效付费计划旨在改善临床实践中的流程和结果。然而，全科医生和患者的特征会影响质量指标的表现。在瑞士，没有关于按绩效付费方法的数据，而且质量指标的使用也微不足道。本研究的目的是描述瑞士初级保健中糖尿病护理的质量指标表现，并分析实践、全科医生和患者特征与质量指标表现的关联。
这项横断面研究使用了电子病历数据库中的医疗常规数据。共纳入 71 名全科医生及其所有糖尿病患者。从 2018 年 7 月开始，我们检索了 12 个月的实践、全科医生和患者特征、实验室值、合并症和合并用药的回顾性数据。基于这些数据，我们评估了糖化血红蛋白、血压、胆固醇的过程和中间结果的质量指标表现，以及实践、全科医生和患者特征与个体和累积质量指标表现的关联。我们使用回归方法计算了比值比（OR）和 95%置信区间（CI）。
我们评估了 3383 名患有糖尿病的患者（57%为男性，平均年龄为 68.3 岁）。平均而言，患者满足了 3.56 个（标准差：1.89）质量指标，而 17.2%的患者满足了所有 6 个质量指标。在实践和全科医生层面，我们没有发现与累积质量指标表现的关联。在患者层面，性别（参考=男性）（OR：0.83，CI：0.78-0.88）、治疗全科医生的数量（OR：0.94，CI：0.91-0.97）、合并症的数量（OR：1.43，CI：1.38-1.47）和就诊次数（OR：1.02，CI：1.02-1.02）与累积质量指标表现相关。
实践、全科医生和患者特征对质量指标表现的影响出人意料地小，瑞士全科医生在糖尿病护理方面似乎还有提高质量指标表现的空间。
