Campbell S M, Roland M O, Quayle J A, Buetow S A, Shekelle P G
National Primary Care Research and Development Centre, University of Manchester.
J Public Health Med. 1998 Dec;20(4):414-21. doi: 10.1093/oxfordjournals.pubmed.a024796.
The aim of the study was to assess the face validity of quality indicators being proposed for use in general practice by health authorities.
A national survey of health authorities was carried out to identify quality indicators being proposed for use in general practice. A two-stage Delphi process was used to establish general practitioners' (GPs') and health authority managers' views on the face validity of identified indicators. A total of 240 separate indicators identified by health authorities and the NHS Executive as potential markers of the quality of general practice care were assessed. Indicators related to access, organizational performance, preventive care, care for a small number of chronic diseases, prescribing and gatekeeping. The subjects were a purposive sample of 47 health authority managers and 57 general practice course organizers.
Thirty-six indicators received median validity scores of 8 or 9 out of a maximum possible score of 9. Of this set, 83 per cent was rated identically by both groups of respondents. Prescribing and gatekeeping indicators generally received low validity scores.
Acceptable face valid indicators were identified for all domains except gatekeeping. However, the indicators rated by the sample do not cover all aspects of care. No indicators were proposed for use by health authorities relating to effective communication, care of acute illness, health outcomes or patient evaluation. Although it is possible to develop indicators of general practice care which have face validity in the view of both GPs and managers, these will be very partial measures of quality. In the indicators used in this study, no explicit distinction was made between indicators designed to assess minimum standards with which all practices should comply, and indicators which could be used to reward higher levels of performance. Failure to separate these will result in antagonism from practitioners to quality improvement initiatives in the NHS, and a failure to engage the profession in improving quality of care.
本研究旨在评估卫生当局提议在全科医疗中使用的质量指标的表面效度。
对卫生当局进行了一项全国性调查，以确定提议在全科医疗中使用的质量指标。采用两阶段德尔菲法来确定全科医生（GPs）和卫生当局管理人员对已确定指标的表面效度的看法。对卫生当局和国民保健服务执行机构确定的总共240个单独指标进行了评估，这些指标被视为全科医疗服务质量的潜在标志。指标涉及可及性、组织绩效、预防保健、少数慢性病的护理、处方开具和把关。研究对象是47名卫生当局管理人员和57名全科医疗课程组织者的目的抽样。
36个指标的效度中位数在满分9分中为8分或9分。在这一组中，两组受访者的评分相同的占83%。处方开具和把关指标的效度评分普遍较低。
除把关外，所有领域都确定了表面效度可接受的指标。然而，样本所评定的指标并未涵盖护理的所有方面。卫生当局未提议使用与有效沟通、急性病护理、健康结果或患者评估相关的指标。尽管有可能制定出在全科医生和管理人员看来具有表面效度的全科医疗服务指标，但这些指标将只是质量的非常片面的衡量标准。在本研究中使用的指标中，未明确区分旨在评估所有医疗机构都应遵守的最低标准的指标和可用于奖励更高绩效水平的指标。不区分这些指标将导致从业者对国民保健服务质量改进举措产生抵触情绪，并使该行业无法参与改善护理质量。
