MEASURING GENERAL PRACTICE A demonstration project to develop and test a set of primary care clinical quality indicators National Primary Care Research and Development Centre, University of Manchester RAND, Santa Monica, CA, USA R MEASURING GENERAL PRACTICE A demonstration project to develop and test a set of primary care clinical quality indicators Professors of General Practice Martin N. Marshall Martin O. Roland Research Fellows Stephen M. Campbell Sue Kirk, David Reeves National Primary Care Research and Development Centre, Williamson Building University of Manchester, Oxford Road, Manchester M13 9PL, UK Vice President, RAND; Director, RAND Health Professor of Medicine and Health Services, UCLA Robert Brook Associate Director RAND Health Elizabeth A. McGlynn Senior Scientist Paul G. Shekelle RAND Health, Main Street, Santa Monica, CA, USA R Copies available in the United States and Canada from RAND 1700 Main St., Santa Monica, CA 90407 Telephone: 310 393 0411 Facsimile: 310 451 6996 email:
[email protected] Website: www.rand.org Library of Congress Cataloging-in-Publication Data Measuring general practice : a demonstration project to develop and test a set of primary care clinical quality indicators / Martin N. Marshall ... [et al.]. p. cm. “MR-1725.” Includes bibliographical references. ISBN 0-8330-3425-1 (pbk.) 1. Primary care (Medicine)—Great Britain—Evaluation. [DNLM: 1. Primary Health Care. 2. Quality Indicators, Health Care. 3. Family Practice. W 84.6 M484 2003] I. Marshall, Martin (Martin N.) II. Rand Corporation. RA399.G7M43 2003 362.1'068'5—dc21 2003010698 ISBN 0-8330-3425-1 © The Nuffield Trust, 2003 Published by The Nuffield Trust 59 New Cavendish Street London WIG 7LP Telephone: 020 7631 8450 Facsimile: 020 7631 8451 E-mail:
[email protected] Website: www.nuffieldtrust.org.uk Charity Number: 209201 Designed by Nicholas Moll Design Telephone: 020 8879 4080 Printed by The Ludo Press Ltd Telephone: 020 8879 1881 CONTENTS Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Chapter 1 The policy context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Chapter 2 Quality indicators for primary care: an overview . . . . . . . . . . . . . . . . . . . . . . . . 13 Chapter 3 Aims and objectives of the project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Chapter 4 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 (i) Indicator development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 (ii) The demonstration project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Chapter 5 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 (i) The indica