Evaluatie van het onderdeel medisch handelen van de accreditering

Abstract

Van Doorn AL, Kirschner K, Bouma M, Burgers JS, Braspenning JCC, Grol RPTM. Evaluation of clinical indicator. Four reliability and validity issues. Huisarts Wet 2010;53(3):141-6. Aim To describe four reliability and validity issues regarding the clinical indicators from the Visitation Instrument Accreditation. Based on this information practices needed to start improvement projects in order to get accreditation. Method An observatorional study based on the medical records of 82 practices. Results The indicators that covered chronic disease management (diabetes, COPD, asthma and cardiovascular risk management), prevention activities (influenza vaccination, cervical cancer screening) and antibiotics policy were weakly correlated, suggesting that the instrument provided a rather broad scope of the practice when it comes to chronic disease management and prevention. Furthermore, the different topics were each measured by indicators that had a sufficient coherence, which suggested that they measured a clear underlying concept. To achieve a reliable indicator score, data from at least 96 patients were necessary when 10% error is allowed. VIA allows to take a sample of 40 patients, but in that case the error margin increases to 15%. To establish a reliable benchmark we needed 233 practices when 5% error is allowed. Conclusion The clinical indicators from VIA are reliable and valid and can be used by a general practice to gain insight into their own performance compared to others. For practice policy on quality improvement an error margin of 10-15% around the indicator score on practice level seems to be acceptable. In case of accountability or a pay-for-performance program we would be more comfortable with a smaller error margin. A sample of 40 patients wouldn’t do. However, it is again and again a search to find the balance between feasibility and justice.