Quality indicators in general practice in selected countries: a scoping review
In August 2021, the division for Health Services in NIPH was commissioned by the Norwegian Directorate of Health to map quality indicators in general practice in a selection of countries. The selected countries were Denmark, Finland, Sweden, England, the Netherlands, and Australia.
In August 2021, the division for Health Services in NIPH was commissioned by the Norwegian Directorate of Health to map quality indicators in general practice in a selection of countries. The selected countries were Denmark, Finland, Sweden, England, the Netherlands, and Australia. We conducted a systematic search for international literature reviews on the topic. We have also searched for grey literature in the Oaister database and Google. For the selected countries, we searched the websites of various relevant organizations and authorities and Google.
The systematic search resulted in 1027 references that we evaluated. Five systematic reviews met the inclusion criteria. We identified seven reports or other types of publications from the Internet searches of grey literature. In addition, we identified websites that look at how the selected countries measure quality, and present indicators measuring quality of general practice.
All countries collected information about the quality of general practice through quality indicators. This report provides a brief overview of the selected country's organization of general practice, the organizations or authorities which measure quality, and relevant indicators are listed in the appendix. How quality is measured, including level and methodological approach, varies between the countries we have reviewed. We have not assessed the confidence of the documentation of the included indicators. Nor did we evaluate the indicator's relevance or feasibility in the Norwegian context. Such an evaluation will be an important next step.
The primary health care service in Norway consists of several municipal services where general practice, including the services provided in a GP practice and the emergency GP practice, is an important part. Reliable information on the quality of the health services at various levels is needed for political decisions, management, monitoring, and local quality improvement and assurance. Quality indicators are an indirect measure of the quality of health services provided. The use of quality indicators is one of several methods to monitor and document the quality of the health care services. Different types of quality indicators are used to measure different dimensions and aspects of quality. For Norway, it will be useful to have an overview of other, comparable countries' measurement systems and indicators.
On behalf of the Norwegian Directorate of Health, the National Institute of Public Health carried out a scoping review to describe how quality of general practice is measured in a selection of relevant countries. The selected countries were Denmark, Finland, Sweden, England, the Netherlands, and Australia. This review aims to briefly describe the selected countries' quality measurement at different levels and present indicators currently in use. The review will also capture international literature studies that present quality indicators for general practice. The following are the research questions this review aims to answer:
- How is quality measured in general practice by use of quantitative measurements, registers, and user surveys in other countries?
- Which quality indicators do other countries have at a national level?
- Which quality indicators do other countries have at the local level?
To answer the research questions, we have searched the websites of various relevant organizations and authorities. We have also searched the Internet using search engines and general keywords for the selected countries. In August 2021, we conducted a systematic search in the databases: MEDLINE, Embase, Web of Science, Epistemonikos, and Cochrane Database of Systematic Reviews. We searched for different types of literature reviews, published from 2010 onwards. We included reviews that provided a system of indicators relevant for quality measurement in general practice or primary health services. We excluded reviews that intended to develop/summarize/evaluate indicators to make international comparisons or restricted to selected health challenges or patient groups, such as only COPD or diabetes. We searched for grey literature in the Oaister database and Google, with the same inclusion criteria. We focused on selecting publications that complement the description of the selected countries' indicator system, e.g., by reporting future changes. Two employees independently selected relevant studies. First by assessing titles, and then by summaries and full texts, according to the inclusion criteria. The review briefly presents the selected countries' organization of general practice, how quality is measured by various registers, user experience surveys, which organizations or authorities measure quality, and relevant indicators for each selected country.
From the literature search, we included five publications. Three publications were different types of literature reviews that were not related to a specific country. Two of the publications were related to the UK's quality indicator system and these are presented along with the description for England. We also identified seven reports or other types of publications from the search for grey literature which complement the description of the selected countries' indicator systems. All selected countries collect information about the quality of their service through quality indicators. How quality is measured, including level and methodological approach and reporting, varied between the countries we reviewed. All selected countries conduct different types of user experience surveys, and all have different types of registers that collect data on various levels. England and Sweden have automatic extraction from patient records for publication at various levels. Denmark only makes patient records available at the local level. The Netherlands and Australia have a database with a representative sample GP practice, where the results of measurements are used primarily for research. Australia and England publish detailed statistics on health personnel and staffing, and Sweden plans several indicators on staffing.
This review provides a comprehensive overview of quality indicators relevant for general practice in the selected countries. We went through many different websites that produce and present results related to quality measurements. We found very different approaches and levels of ambition between the countries in terms of number of and types of indicators, reporting levels, and presentation of results. Access to data will often govern which quality indicators that are possible to report. In further work on the selection and adaptation of indicators to the Norwegian context and health care system, available data sources will be part of the assessment. We have not assessed what is possible or meaningful to measure in a Norwegian context. Also, we did not assess which quality dimensions the various indicators measure, or whether the included indicator sets are research-based or good quality indicators. This will be an important next step.
This review provides an overview of how quality in general practice is measured in a selection of relevant countries by describing quality measurements at different levels and presenting examples of indicators. The selected countries present data at both local, regional, and national levels. The results from this review can be used in the development of quality indicators for general practice in Norway.