Background
Methods
Study design and recruitment of participants
Data set
Statistical analyses
Selecting the core sets
Assessing the properties of the selected indicators
Analysing construct validity of the quality scores
Results
Study population
Characteristic | Total (n = 346) |
---|---|
Age (in years): median [interquartile range] | 78 [72–83] |
Sex: | |
- Female | 55.2% |
- Male | 44.8% |
Living situation: living alone | 35.8% |
Education (pursuant to CASMIN): | |
- Uncompleted, general elementary or basic vocational | 56.1% |
- Secondary school certificate or A-level equivalent | 27.9% |
- Tertiary education | 16.0% (n = 344) |
Migration background: | |
- Patient and both parents born in Germany | 88.0% |
- Patient born in Germany and at least one parent abroad | 4.4% |
- Patient born abroad | 7.6% (n = 342) |
Number of chronic conditions (39 categories): median [interquartile range] | 10 [7–15] |
Health-related quality of life (pursuant to EQ-5D-5L, German value set): median [interquartile range] | 0.84 [0.62–0.94] (n = 337) |
Self-rated Health (visual analogue scale): median [interquartile range] | 65 [50–80] (n = 340) |
Number of contacts with GP (last 3 months): median [interquartile range] | 2 [1–3] (n = 339) |
Enrolment in a disease management programme | 44.6% (n = 343) |
Patient satisfaction (willingness to recommend the GP): | |
- “Definitely no” or “rather no” | 10.4% |
- “Definitely yes” or “rather yes” | 89.6% (n = 336) |
Willingness to use GP as coordinator of treatment (pursuant to F-HaBi): median [interquartile range] | 22 [19–24] (n = 340) |
Chronic conditions | Prevalence in the sample (n = 346) |
---|---|
Hypertension | 68.2% |
Chronic low back paina | 59.2% |
Osteoarthritisa | 47.4% |
Diabetes mellitusa | 40.8% |
Dyslipidaemia | 35.3% |
Chronic ischaemic heart diseasea | 34.1% |
Asthma/chronic obstructive pulmonary diseasea | 29.2% |
Cancera | 29.2% |
Depressiona | 27.8% |
Thyroid dysfunction | 24.9% |
Chronic gastritis/gastro-oesophageal reflux disease | 24.6% |
Atherosclerosis/peripheral arterial occlusive diseasea | 21.7% |
Cardiac arrhythmia | 20.5% |
Osteoporosisa | 19.1% |
Neuropathya | 18.8% |
Obesitya | 17.6% |
Heart failurea | 17.3% |
Urinary incontinencea | 15.3% |
Varicose veins of lower extremities | 13.9% |
Renal failure | 13.3% |
Intestinal diverticulosis | 11.6% |
Heart valve disease | 10.1% |
Severe visual impairment | 10.1% |
Cerebral ischaemia/chronic stroke | 9.5% |
Rheumatoid arthritis/chronic polyarthritisa | 8.7% |
Vertigoa | 8.1% |
Somatoform disorders | 7.8% |
Insomnia | 7.8% |
Hyperuricemia/gout | 7.5% |
Liver disease | 6.4% |
Prostatic hyperplasia | 5.5% |
Chronic cholecystitis/gallstones | 5.2% |
Selection of the core sets
Step | Item-total correlation | Quality indicator | Performance | Missing values |
---|---|---|---|---|
1 | < 0.001 | Assessment of biopsychosocial support needs according to ICFa (n = 325) | 0% | 6.1% |
2 | 0.036 | Identification of patients with multimorbidity (n = 345) | 18.0% | 0.3% |
3 | 0.097 | Documentation of adverse drug reactions (n = 35) | 38.2% | 2.9% |
4 | 0.157 | Addressing financial support needs (n = 325) | 19.1% | 7.5% |
5 | 0.168 | Information about medication (n = 333)b | 98.8% | 1.5% |
6 | 0.188 | Regular updates of medication plan (n = 301)c | 52.2% | 2.6% |
7 | 0.179 | Assessment of symptom burden (n = 333) | 14.7% | 3.8% |
8 | 0.204 | Screening for depression (n = 266)d | 13.2% | 8.0% |
9 | 0.254 | Written treatment plan (n = 330) | 9.1% | 4.6% |
10 | 0.248 | Facilitating patient education and self-management (n = 285) | 23.9% | 17.6% |
11 | 0.250 | Comprehensive care documentation (n = 344) | 81.4% | 0.6% |
12 | 0.267 | Assigning responsibility for coordination of care (n = 333) | 28.8% | 3.8% |
Step | Item-total correlation | Quality indicator | Performance | Missing values |
---|---|---|---|---|
1 | 0.136 | Written treatment plan (n = 338) | 6.5% | 2.3% |
2 | 0.123 | Facilitating patient education and self-management (n = 325) | 40.9% | 6.1% |
3 | 0.163 | Regular updates of medication plan (n = 315)a | 74.0% | 0.6% |
4 | 0.186 | Addressing financial support needs (n = 333) | 6.3% | 3.8% |
5 | 0.197 | Shared decision-making (n = 330) | 74.5% | 4.6% |
6 | 0.236 | Involving partner, family and caregivers (n = 336) | 43.5% | 2.9% |
7 | 0.271 | Information about potential benefits and harms of treatment options (n = 183) | 63.4% | 47.1% |
Target level of health care | Care domains | Quality indicator | Representation |
---|---|---|---|
Patient factors | Physical and mental health | Proactive pain assessment | GP and patient report |
Screening for depression | Excluded | ||
Identification of patients with multimorbidity | Excluded | ||
Personal background and living environment | Involving partner, family and caregivers | GP report | |
Addressing financial support needs | Excluded | ||
Coping and skills | Monitoring adherence to treatment | GP report | |
Facilitating patient education and self-management | Excluded | ||
Quality of life | Quality of life assessment | GP report | |
Assessment of symptom burden | Excluded | ||
Assessment of biopsychosocial support needs according to ICF | Excluded | ||
Patient preferences | Eliciting patient preferences | GP and patient report | |
Patient-provider communication | Information and decision-making | Mutual agreement on treatment goals | GP and patient report |
Information about potential benefits and harms of treatment options | GP report | ||
Information about medication | Patient report | ||
Shared decision making | Excluded | ||
Care planning and clinical management | Assessment of treatment burden | GP and patient report | |
Medication review | GP and patient report | ||
Monitoring of pain management | GP report | ||
Written treatment plan | Excluded | ||
Documentation of adverse drug reactions | Excluded | ||
Regular updates of medication plan | Excluded | ||
Context and organisational structures | Coordination | Assigning responsibility for coordination of care | Patient report |
Comprehensive care documentation | Excluded | ||
Training | Training of physician staff addressing multimorbidity | GP report | |
Training of non-physician staff addressing multimorbidity | GP report |
Properties of the selected indicators
Validity | Discriminative capacity | Feasibility | Patient-professional agreement | ||||||
---|---|---|---|---|---|---|---|---|---|
Item-total | Factor loadingsa | Performance | Floor effects | Ceiling effects | Documentation | Missing values | Positive | Negative | |
GP-reported quality indicators | |||||||||
Eliciting patient preferences (n = 323) | 0.576 | 0.673 | 46.1% | 11.8% | 5.9% | 69.1% | 6.6% | 49.4% | 61.0% |
Quality of life assessment (n = 321) | 0.512 | 0.643 | 80.1% | 2.9% | 28.6% | 60.3% | 7.2% | -g | -g |
Mutual agreement on treatment goals (n = 313) | 0.501 | 0.612 | 48.6% | 11.4% | 2.9% | 73.0% | 9.5% | 54.1% | 54.4% |
Assessment of treatment burden (n = 308) | 0.435 | 0.613 | 75.0% | 2.9% | 31.4% | 57.0% | 11.0% | 43.5% | 42.8% |
Medication review (n = 295)b | 0.423 | 0.476 | 39.0% | 41.2% | 11.8% | 62.3% | 12.7% | 54.1% | 43.4% |
Training of non-physician staff addressing multimorbidity (n = 35)c | 0.416 | 0.479 | 60.6% | -e | -e | -f | 5.7% | -g | -g |
Monitoring adherence to treatment (n = 313) | 0.387 | 0.474 | 47.0% | 14.7% | 8.8% | 50.3% | 9.5% | -g | -g |
Monitoring of pain management (n = 203)d | 0.385 | 0.430 | 67.0% | 5.9% | 26.5% | 65.4% | 1.5% | -g | -g |
Involving partner, family and caregivers (n = 317) | 0.376 | 0.431 | 33.8% | 35.3% | 5.9% | 72.0% | 8.4% | 36.1% | 59.8% |
Training of physician staff addressing multimorbidity (n = 35)b | 0.372 | 0.438 | 71.4% | -e | -e | -f | 0% | -g | -g |
Proactive pain assessment (n = 324) | 0.335 | 0.423 | 62.3% | 2.9% | 17.1% | 69.8% | 6.4% | 47.8% | 53.2% |
Information about benefits and harms of treatment options (n = 318) | 0.332 | 0.488 | 89.0% | 2.9% | 34.3% | 59.2% | 8.1% | 75.9% | 24.1% |
Patient-reported quality indicators | |||||||||
Eliciting patient preferences (n = 323) | 0.440 | 0.535 | 41.2% | 11.4% | 2.9% | -i | 6.6% | 49.4% | 61.0% |
Assessment of treatment burden (n = 329) | 0.370 | 0.459 | 24.6% | 28.6% | 0% | -i | 4.9% | 43.5% | 42.8% |
Information about medication (n = 227)h | 0.362 | 0.311 | 84.1% | 0% | 91.4% | -i | 12.4% | 90.7% | 5.1% |
Mutual agreement on treatment goals (n = 334) | 0.348 | 0.446 | 50.3% | 8.6% | 5.7% | -i | 3.5% | 54.1% | 54.4% |
Proactive pain assessment (n = 327) | 0.345 | 0.436 | 30.9% | 14.3% | 0% | -i | 5.5% | 47.8% | 53.2% |
Medication review (n = 336)b | 0.343 | 0.416 | 69.1% | 2.9% | 5.7% | -i | 0.9% | 54.1% | 43.4% |
Assigning responsibility for coordination of care (n = 332) | 0.339 | 0.421 | 44.0% | 11.4% | 0% | -i | 4.0% | 33.3% | 61.8% |
Construct validity of the quality scores
Characteristic | ß (95% CI) | p |
---|---|---|
Age (per 10 years) | 0.12 (− 0.23/0.48) | 0.500 |
Sex: | ||
- Women | Reference | |
- Men | 0.08 (− 0.44/0.60) | 0.763 |
Living situation | ||
- Living together with others | Reference | |
- Living alone | 0.29 (− 0.23/0.81) | 0.275 |
Educational level (pursuant to CASMIN): | ||
- Uncompleted, general elementary or basic vocational | Reference | |
- Secondary school certificate or A-level equivalent | − 0.08 (− 0.63/0.48) | 0.785 |
- Tertiary education | 0.09 (− 0.64/0.82) | 0.808 |
Migration background: | ||
- Patient and both parents born in Germany | Reference | |
- Patient born in Germany and at least one parent abroad | − 0.58 (− 1.77/0.61) | 0.339 |
- Patient born abroad | − 1.04 (− 2.00/ − 0.08) | 0.033 |
Number of chronic conditions | 0.05 (− 0.02/0.11) | 0.167 |
Self-rated health (visual analogue scale, per 10 points) | 0.05 (− 0.10/0.19) | 0.505 |
Health-related quality of life (pursuant to EQ-5D-5L, German value set) | − 1.37 (− 2.39/ − 0.36) | 0.008 |
Number of contacts with GP (last 3 months) | 0.14 (0.04/0.23) | 0.007 |
Enrolment in a disease management programme | 0.52 (0.00/1.05) | 0.050 |
Patient satisfaction: willingness to recommend the GP | − 0.71 (− 1.54/0.12) | 0.094 |
Willingness to use GP as coordinator of treatment (pursuant to F-HaBi) | 0.13 (0.06/0.20) | < 0.001 |
Characteristic | ß (95% CI) | p |
---|---|---|
Age (per 10 years) | − 0.12 (− 0.40/0.16) | 0.391 |
Sex: | ||
- Women | Reference | |
- Men | 0.03 (− 0.38/0.44) | 0.880 |
Living situation | ||
- Living together with others | Reference | |
- Living alone | 0.33 (− 0.08/0.73) | 0.116 |
Educational level (pursuant to CASMIN): | ||
- Uncompleted, general elementary or basic vocational | Reference | |
- Secondary school certificate or A-level equivalent | 0.11 (− 0.32/0.54) | 0.623 |
- Tertiary education | 0.01 (− 0.55/0.58) | 0.960 |
Migration background: | ||
- Patient and both parents born in Germany | Reference | |
- Patient born in Germany and at least one parent abroad | − 0.24 (− 1.18/0.71) | 0.623 |
- Patient born abroad | 0.41 (− 0.35/1.16) | 0.290 |
Number of chronic conditions | 0.03 (− 0.01/0.06) | 0.125 |
Self-rated Health (visual analogue scale, per 10 points) | − 0.06 (− 0.18/0.05) | 0.289 |
Health-related quality of life (pursuant to EQ-5D-5L, German value set) | 0.16 (− 0.63/0.96) | 0.686 |
Number of contacts with GP (last 3 months) | 0.12 (0.04/0.20) | 0.002 |
Enrolment in a disease management programme | − 0.25 (− 0.64/0.14) | 0.211 |
Patient satisfaction: willingness to recommend the GP | 0.46 (− 0.19/1.11) | 0.162 |
Willingness to use GP as coordinator of treatment (pursuant to F-HaBi) | 0.16 (0.10/0.21) | < 0.001 |