EPA: EUROPEAN PRACTICE ASSESSMENT

1. EPA: EUROPEAN PRACTICE ASSESSMENT • Researcher: Yvonne Engels • Project leader: Richard Grol • Co-ordinator: Maaike Dautzenberg • Financed by: Bertelsmann foundation Germany

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

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

4. Methods: • Literature review • Workshops with partners • Consensus procedures - with EPA-partners - Delphi • Pilot

5. Good practice management: • “Systems (structures and processes) meant to enable the delivery of good quality patient care”

6. Framework • Infrastructure • Staff • Information • Finance • Quality and safety

7. 170 indicators, e.g.: • Domain: INFRASTRUCTURE • Dimension: medical equipment • Indicator: The emergency bag is complete

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

9. 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%)

10. Exercise 1 • Which indicators do you rate useful? • (groups of about 6 persons, preferably from different countries

11. 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

12. 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

13. 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

14. 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

15. 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)

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

17. Result of the pilot • Feedback on individual practice level • National data • International comparisons.

19. Visotool/ Startbildschirm

20. Online-Feedback Basisdaten der Praxis(insgesamt 4 Bildschirmseiten)

22. Ergebnisse/Dimensionen(Bsp. Infrastruktur: Übersicht)

23. Ergebnisse/Dimensionen(Bsp. Infrastruktur: Streudiagramm)

24. To Do list (example)

25. Patient participation (%) • complaint procedure • Belgium 3 • France 3 • Germany 25 • Netherlands 75 • Switzerland 25 • UK 100 • Slovenia 77 • Austria 55

26. 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

27. 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

28. Leaflets (%) • pract. inf. • Belgium 41 • France 42 • Germany 55 • Netherlands 88 • Switzerland 48 • England 87 • Slovenia 48 • Austria 27

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

30. 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

31. 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

32. 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

33. 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)?

34. What next? • Validation of the instrument: (acceptable, feasible, valid, sensitive) • Adapted version: next year • International data warehouse

35. EPA-book: • January 2005 • y.engels@wok.umcn.nl • www.wokresearch.nl • www.aqua-institut.de (information Visotool)