[State of knowledge: primary care and service quality indicators for supporting continuous quality improvement in Québec’s family medicine groups]

Beaulieu M-D, Martin G
Record ID 32018002349
Original Title: État des connaissances - Regard sur les Groupes de médecine de famille au Québec et proposition de segmentation de la population pour appuyer les démarches d’amélioration continue de la qualité selon les besoins de santé
Authors' objectives: Given its mission and access to several clinical administrative databases under a tripartite agreement with the MSSS and the Régie de l'assurance maladie du Québec (RAMQ), INESSS is in a unique position to support family medicine groups (FMGs) in their continuous quality improvement initiatives by generating information to supplement that available in the FMGs. It was in this context that INESSS initiated the Repères GMF (FMG landmarks) project, whose main objective is to develop a set of measurable quality indicators for primary care and services, using the clinical administrative databases to which it has access. This set of indicators is based on existing models and involved mobilizing the knowledge of health professionals, researchers, administrators and users, as well as taking into account the constraints imposed by the structure of the available information systems.
Authors' results and conclusions: RESULTS: The attributes of primary care services identified as being important by users and reported in the literature and the focus group were consistent with the dimensions of the IOM framework. A total of 165 indicators were identified from the various information sources consulted: 117 quality indicators and 48 descriptive indicators. An initial selection process with the advisory committee led us to propose 33 quality indicators that take teamwork into account and that are not overly specific to a given disease. The committee’s members pointed out that including the dimension of equity will make it possible to mobilize the teams around health determinant-related issues and thus encourage reflection on the social dimension of interventions. They stated that certain indicators, such as timely access, effectiveness, efficiency, and patient-centricity, should be examined through an equity lens. 2 Given that producing indicators is a demanding task and that it is wise to limit the number of indicators in the context of a pilot test, only those quality indicators that INESSS will be able to measure within three to six months were considered for the prioritization exercise carried out by the advisory committee. Thus, from the 33 quality indicators in question, 18 were chosen. At the end of the exercise, the following six were selected: • Emergency department visits triaged as P4/P5 priorities (for all visits and according to the time of the day) • Continuity of location (over 1 and 3 years) • Relational continuity (over 1 and 3 years) • Retinal examination in persons with diabetes • Polypharmacy in people aged 65 years and older • Prescription for a benzodiazepine in people aged 65 and over In addition to the quality indicators, a set of descriptive indicators will enable the teams to examine their clientele’s characteristics. CONCLUSION: The Repères GMF project is shifting away from a perspective aimed at assessing the quality of professional practice to an organizational perspective aimed at continuous improvement in the quality of care and services based on patient needs. With a view to offering care and services tailored to the needs of the FMGs’ clientele, the selected indicators will be produced according to clientele segments with similar health needs. In this regard, it must be recognized that an FMG’s clientele is not homogeneous and that the manner in which services are organized and quality indicators are defined should be based on the needs of the different patient groups. The prioritized indicators will be presented in the form of individualized feedback to each FMG team as part of a pilot project involving a small number of FMGs. This new knowledge can then be used locally by FMGs by integrating it into their practice facilitation and continuous quality improvement activities
Authors' methods: The methodological approach included three key steps: an exploratory review of the literature on quality indicators and the dimensions of quality that are important to users, the selection and prioritization of indicators, and stakeholder consultations. The selection of quality indicators was guided by the Institute of Medicine (IOM)’s six dimensions of quality, the functions of primary healthcare, and the characteristics of a good indicator. The quality indicators were then prioritized according to their ability to measure processes or effects that help improve the overall value of the primary care services provided in FMGs, based on INESSS’s value assessment framework.
Project Status: Completed
Year Published: 2022
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Family Practice
  • General Practitioners
  • Physicians, Family
  • Physicians, Primary Care
  • Health Care Quality, Access, and Evaluation
  • Health Services Accessibility
  • Quality Improvement
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.