Verburg Arie C, van Dulmen Simone A, Kiers Henri, Nijhuis-van der Sanden Maria W G, van der Wees Philip J
Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands.
ERJ Open Res. 2022 Aug 15;8(3). doi: 10.1183/23120541.00008-2022. eCollection 2022 Jul.
To estimate the comparability and discriminability of outcome-based quality indicators by performing a practice test in Dutch physical therapy primary care, and to select a core set of outcome-based quality indicators that are well accepted by physical therapists based on their perceived added value as a quality improvement tool.
First, a list of potential quality indicators was defined, followed by determination of the comparability (case-mix adjusted multilevel analysis) and discriminability (intraclass correlation coefficient (ICC)). Second, focus group meetings were conducted with stakeholders (physical therapists and senior researchers) to select a core set of quality indicators.
Overall, 229 physical therapists from 137 practices provided 2651 treatment episodes. Comparability: in 10 of the 11 case-mix adjusted models, the ICC increased compared with the intercept-only model. Discriminability: the ICC ranged between 0.01 and 0.34, with five of the 11 ICCs being >0.10. The majority of physical therapists in each focus group preferred the inclusion of seven quality indicators in the core set, including three process and four outcome indicators based upon the 6-min walk test (6MWT), the Clinical COPD Questionnaire (CCQ), and the determination of quadriceps strength using a hand-held dynamometer.
This is the first study to describe the comparability and discriminability of the outcome-based quality indicators selected for patients with COPD treated in primary care physical therapy practices. Future research should focus on increasing data collection in daily practice and on the development of tangible methods to use as the core set of a quality improvement tool.
通过在荷兰物理治疗初级保健中进行实践测试，评估基于结果的质量指标的可比性和区分性，并根据物理治疗师认为其作为质量改进工具的附加值，选择一组被他们广泛接受的基于结果的核心质量指标。
首先，定义一份潜在质量指标清单，随后确定可比性（病例组合调整多层分析）和区分性（组内相关系数（ICC））。其次，与利益相关者（物理治疗师和资深研究人员）进行焦点小组会议，以选择一组核心质量指标。
总体而言，来自137家诊所的229名物理治疗师提供了2651个治疗案例。可比性：在11个病例组合调整模型中的10个中，与仅含截距的模型相比，ICC有所增加。区分性：ICC范围在0.01至0.34之间，11个ICC中有5个大于0.10。每个焦点小组中的大多数物理治疗师倾向于在核心集中纳入7个质量指标，包括基于6分钟步行试验（6MWT）、慢性阻塞性肺疾病临床问卷（CCQ）以及使用手持测力计测定股四头肌力量的3个过程指标和4个结果指标。
这是第一项描述在初级保健物理治疗实践中为慢性阻塞性肺疾病患者选择的基于结果的质量指标的可比性和区分性的研究。未来的研究应侧重于增加日常实践中的数据收集以及开发切实可行的方法，以用作质量改进工具的核心集。
