Skip to main content
PMC home page
Quality in Health Care : QHC logoLink to Quality in Health Care : QHC
. 2000 Jun;9(2):90–97. doi: 10.1136/qhc.9.2.90

Clinical governance in primary care groups: the feasibility of deriving evidence-based performance indicators

A McColl 1, P Roderick 1, E Wilkinson 1, J Gabbay 1, H Smith 1, M Moore 1, M Exworthy 1
PMCID: PMC1743509  PMID: 11067257

Abstract

Helen Smith, senior lecturer in primary care

Michael Moore, general practitioner

Mark Exworthy, research fellow

Objectives—To test the feasibility of deriving comparative indicators in all the practices within a primary care group.

Design—A retrospective audit using practice computer systems and random note review.

Setting—A primary care group in southern England.

Subjects—All 18 general practices in a primary care group.

Main outcome measures—Twenty six evidence-based process indicators including aspirin therapy in high risk patients, detection and control of hypertension, smoking cessation advice, treatment of heart failure, raised cholesterol levels in those with established cardiovascular disease, and the treatment of atrial fibrillation. Feasibility was tested by examining whether it was possible to derive these indicators in all the practices; the problems and constraints incurred when collecting data; the variations in indicator values between practices in both their identification of diseases and in the uptake of various interventions; the possible reasons for these variations; and the cost of generating such indicators.

Results—It was possible to derive eight indicators in all practices and in three practices all 26 indicators. The median number of indicators derived was 12 with two practices able to generate eight. There was considerable variation in the use of computers between practices and in the ability and ease of various practice computer systems to generate indicators. Practices varied greatly in the identification of diseases and in the uptake of effective interventions. Variation in identification of ischaemic heart disease could not be explained by a higher prevalence in practices with a more deprived population. The cost of generating these indicators was £5300.

Conclusion—Comparative evidence-based indicators, used as part of clinical governance in primary care groups, could have the potential to turn evidence into everyday practice, to improve the quality of patient care, and to have an impact on the population's health. However, to derive such indicators and to be able to make meaningful comparisons primary care groups need greater conformity and compatibility of computer systems, improved computer skills for practice staff, and appropriate funding.

(Quality in Health Care 2000;9:90–97)

Key Words: performance indicators; primary care; primary care groups; feasibility study; clinical governance

Full Text

The Full Text of this article is available as a PDF (143.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buetow S. A., Roland M. Clinical governance: bridging the gap between managerial and clinical approaches to quality of care. Qual Health Care. 1999 Sep;8(3):184–190. doi: 10.1136/qshc.8.3.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cranney M., Barton S. Performance indicators for primary care groups. Performance of these indicators is critical. BMJ. 1999 Mar 20;318(7186):804–805. [PubMed] [Google Scholar]
  3. Gulliford M. C., Petruckevitch A., Burney P. G. Hospital case notes and medical audit: evaluation of non-response. BMJ. 1991 May 11;302(6785):1128–1129. doi: 10.1136/bmj.302.6785.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Jick H., Jick S. S., Derby L. E. Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. BMJ. 1991 Mar 30;302(6779):766–768. doi: 10.1136/bmj.302.6779.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kannel W. B., Belanger A. J. Epidemiology of heart failure. Am Heart J. 1991 Mar;121(3 Pt 1):951–957. doi: 10.1016/0002-8703(91)90225-7. [DOI] [PubMed] [Google Scholar]
  6. Langenberg M., Hellemons B. S., van Ree J. W., Vermeer F., Lodder J., Schouten H. J., Knottnerus J. A. Atrial fibrillation in elderly patients: prevalence and comorbidity in general practice. BMJ. 1996 Dec 14;313(7071):1534–1534. doi: 10.1136/bmj.313.7071.1534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Lip G. Y., Golding D. J., Nazir M., Beevers D. G., Child D. L., Fletcher R. I. A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project. Br J Gen Pract. 1997 May;47(418):285–289. [PMC free article] [PubMed] [Google Scholar]
  8. McColl A., Roderick P., Gabbay J., Smith H., Moore M. Performance indicators for primary care groups: an evidence based approach. BMJ. 1998 Nov 14;317(7169):1354–1360. doi: 10.1136/bmj.317.7169.1354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. McDonagh T. A., Morrison C. E., Lawrence A., Ford I., Tunstall-Pedoe H., McMurray J. J., Dargie H. J. Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet. 1997 Sep 20;350(9081):829–833. doi: 10.1016/S0140-6736(97)03033-X. [DOI] [PubMed] [Google Scholar]
  10. Myers P. Performance indicators for primary care groups. Current indicators have been chosen for ease of collection rather than scientific validity. BMJ. 1999 Mar 20;318(7186):803–805. [PMC free article] [PubMed] [Google Scholar]
  11. Newrick D. C., Spencer J. A., Jones K. P. Collecting data in general practice: need for standardisation. BMJ. 1996 Jan 6;312(7022):33–34. doi: 10.1136/bmj.312.7022.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Pringle M., Ward P., Chilvers C. Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer. Br J Gen Pract. 1995 Oct;45(399):537–541. [PMC free article] [PubMed] [Google Scholar]
  13. Scanlon T., Tarrant P. Performance indicators for primary care groups. Local consensus opinion must be reflected. BMJ. 1999 Mar 20;318(7186):803–805. [PubMed] [Google Scholar]
  14. Shah S., Cook A. Performance indicators for primary care groups. Will they discriminate against small general practices? BMJ. 1999 Mar 20;318(7186):803–805. [PubMed] [Google Scholar]
  15. Whitelaw F. G., Nevin S. L., Milne R. M., Taylor R. J., Taylor M. W., Watt A. H. Completeness and accuracy of morbidity and repeat prescribing records held on general practice computers in Scotland. Br J Gen Pract. 1996 Mar;46(404):181–186. [PMC free article] [PubMed] [Google Scholar]

Articles from Quality in Health Care : QHC are provided here courtesy of BMJ Publishing Group

RESOURCES