EPA: EUROPEAN PRACTICE ASSESSMENT

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EPA EUROPEAN PRACTICE ASSESSMENT

• Researcher Yvonne Engels
• Project leader Richard Grol
• Co-ordinator Maaike Dautzenberg
• Financed by Bertelsmann foundation Germany

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Collaboration

• Belgium (Flanders),
• France,
• Germany,
• Switzerland,
• the Netherlands,
• UK (Wales and England)
• Bertelsmann Foundation

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Aim

• to develop a practice assessment method that
  assists family/general practitioners in improving
  their practice performance

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Methods

• Literature review
• Workshops with partners
• Consensus procedures - with EPA-partners -
  Delphi
• Pilot

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Good practice management

• Systems (structures and processes) meant to
  enable the delivery of good quality patient care

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Framework

• Infrastructure
• Staff
• Information
• Finance
• Quality and safety

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170 indicators, e.g.

• Domain INFRASTRUCTURE
• Dimension medical equipment
• Indicator The emergency bag is complete

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Modified Rand procedure

• 170 indicators
• Translation of the draft set of indicators
• Delphi procedure
• Rated by 10 GPs / experts in 6 countries

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Indicators rated useful (of 168)

• By all countries 62 (37)
• France 103 (61)
• Germany 103 (61)
• Swiss 116 (69)
• Belgium 121 (72)
• Netherlands 125 (74)
• England/Wales 142 (85)

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Exercise 1

• Which indicators do you rate useful?
• (groups of about 6 persons, preferably from
  different countries

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A. Information for patients about clinical care 0

• An up-to-date selection of books and videos is
  available to patients
• A range of leaflets and brochures is available
  for patients to read in the practice or to take
  home
• Translator services are available on request
• Information leaflets are available in appropriate
  languages
• The practice information sheet is available in
  appropriate languages

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B. Non-medical equipment 4

• The practice has an operational fax
• The practice has at least one computer for staff
• The practice has an internet connection
• All computers are protected against inappropriate
  access
• Every GP has access to e-mail
• Every GP has access to the internet (www)
• The practice has a telephone system with
  sufficient inward and outward capacity
• The practice has a separate emergency telephone
  line
• All electronical medical equipment is checked
  annually
• All safety equipment (e.g. fire extinguisher) is
  checked annually

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C. Detection of quality and safety problems 0

• The practice has undertaken at least one clinical
  audit in the last year
• The practice has a critical incident register
• The practice has a documented process to follow
  up and analyse critical incidents
• The practice has a formal consultation process
  with patients (patient forum or participation
  group)
• The practice has a suggestion box for patients
• The practice has a written patient complaint
  procedure
• The written patient complaint procedure is
  available at the reception

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D. Working conditions 2

• The practice monitors the workload of its staff
• The practice monitors stress levels of its staff
• The practice evaluates team working in the
  organisation
• The practice has had at least one away day last
  year
• Staff experience a pleasant working atmosphere
• The practice has a policy which enables staff to
  offer suggestions for improving practice
  management
• The practice has written arrangements to ensure
  the availability of a locum GP when needed

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The Instrument

• Short self-administered questionnaires
• Representative of the practice
• individual GPs
• staff members
• Patients
• Observer/facilitator visits the practice
• Structured interview with GP/PM
• Checklist
• (Maturity Matrix)

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The pilot

• Pretest in 3 practices per country
• September 2003-May 2004
• Pilot in 30 practices per country , also in
  Slovenia, Austria and Israel

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Result of the pilot

• Feedback on individual practice level
• National data
• International comparisons.

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(No Transcript)
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Visotool/ Startbildschirm
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Online-Feedback Basisdaten der Praxis(insgesamt
4 Bildschirmseiten)
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(No Transcript)
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Ergebnisse/Dimensionen(Bsp. Infrastruktur
Übersicht)
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Ergebnisse/Dimensionen(Bsp. Infrastruktur
Streudiagramm)
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To Do list (example)
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Patient participation ()

• complaint procedure
• Belgium 3
• France 3
• Germany 25
• Netherlands 75
• Switzerland 25
• UK 100
• Slovenia 77
• Austria 55

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Survey patient satisfaction ()

• (n)
• Belgium (31) 23
• France (17) 3
• Germany (32) 39
• Netherlands (32) 38
• Switzerland (28) 64
• UK (27) 85
• Slovenia (31) 53
• Austria (33) 24

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Europep

• GP Practice
• Belgium (31) 91 85
• France (17) 85 72
• Germany (32) 84 83
• Netherlands (32) 85 72
• Switzerland (28) 91 90
• UK (27) 81 69
• Slovenia (31) 90 87
• Austria (33) 93 91

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Leaflets ()

• pract. inf.
• Belgium 41
• France 42
• Germany 55
• Netherlands 88
• Switzerland 48
• England 87
• Slovenia 48
• Austria 27

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Medical registration

• ICPC etc
• Belgium 52
• France 24
• Germany 100
• Netherlands 87
• Switzerland 29
• UK 100
• Slovenia 100
• Austria 12

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Patient list ()

• Belgium (31) 81
• France (29) 0
• Germany (32) 0
• Netherlands (32) 100
• Switzerland (28) 74
• UK (27) 100
• Slovenia (31) 100
• Austria (33) 0

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System for recalling patients with

• Asthma Diabetes CHD
• Belgium 65 42 32
• France 0 0 0
• Germany 22 47 28
• Netherlands 62 91 50
• Switzerland 14 32 21
• UK 96 100 96
• Slovenia 16 35 32
• Austria 12 24 12

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System for recalling populations at risk

• CHD Influenza vacc
• Belgium 16 42
• France 0 0
• Germany 16 41
• Netherlands 56 100
• Switzerland 7 68
• UK 74 96
• Slovenia 97 68
• Austria 0 0

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Exercise 2

• Discuss in small groups
• Do general practices in your country have systems
  to recall
• patients with specific chronic diseases? Why
  (not)?
• Populations at risk? Why (not)?

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What next?

• Validation of the instrument (acceptable,
  feasible, valid, sensitive)
• Adapted version next year
• International data warehouse

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EPA-book

• January 2005
• y.engels_at_wok.umcn.nl
• www.wokresearch.nl
• www.aqua-institut.de (information Visotool)