Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany.
BMJ Open. 2021 Jun 15;11(6):e047025. doi: 10.1136/bmjopen-2020-047025.
Prevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients' perspective and match them to a literature-based set of QIs.
We conducted eight focus groups with patients with multimorbidity and three focus groups with patients' relatives using a semistructured guide. Data were analysed using Kuckartz's qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.
We created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants' accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.
We show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.
German clinical trials registry (DRKS00015718), Pre-Results.
患有多种疾病的人群比例不断上升。多种疾病给医疗体系带来了挑战，同时也增加了治疗多种疾病患者的难度，导致治疗质量参差不齐。目前，尚无一套质量指标（QI）用于评估医疗质量，更不用说纳入患者视角了。因此，我们旨在确定与患者视角相关的医疗质量方面，并将其与基于文献的一套质量指标相匹配。
我们使用半结构化指南，对患有多种疾病的患者进行了 8 组焦点小组讨论，对患者的亲属进行了 3 组焦点小组讨论。使用 Kuckartz 的定性内容分析法对数据进行分析。我们从文献中推导出演绎类别，添加了归纳类别（新的质量方面）并将其转化为 QI。
我们根据与患者/亲属相关的质量方面创建了四个新的 QI。两个 QI（患者教育/自我管理、定期更新药物计划）得到了专家小组的认可，而另外两个 QI（定期检查、全科医生协调护理）则没有得到认可。例如，基于文献的 QI 中的一半，即评估生物心理社会支持需求，得到了参与者的认可，而焦点小组中没有涉及更多关于评估和治疗方案的技术领域。
我们表明，默认情况下，应将患者和亲属焦点小组纳入 QI 开发，以补充传统的 QI 开发。我们的 QI 集构成了评估德国医疗体系医疗质量的框架。它将有助于实施治疗标准并增加现有指南的使用，从而有助于减少治疗多种疾病患者的医疗资源过度使用、使用不足和滥用。
德国临床试验注册处（DRKS00015718），预结果。
