Implementation of ambulatory health care quality standards in an Occupational Mutual Insurance Company

To describe the implementation of Health Care Quality Standards (HCQS) to evaluate quality of care and its impact on the culture of continuous improvement in the outpatient centres of an Occupational Mutual Insurance Company (OMIC) collaborating with the Spanish Social Security.

Fifty HCQS were selected from the Joint Commission model and the Departament de Salut of the Government of Catalonia, both used as gold-standard references, and were adapted to the OMIC context. As an implementation strategy, 20 HCQS were initially deployed. Compliance values were rescaled and weighted, and the system was refined through training sessions prior to implementation in 2022, building on a 2021 pilot test. A multidisciplinary focus group rated the intensity of the actions undertaken for each HCQS and the magnitude of the resulting improvements.

The mean HCQS score in outpatient centres increased progressively from 8.2 in 2021 to 8.5 in 2022, 8.8 in 2023 and 8.9 in 2024 (0-10 scale). HCQS were grouped into those consistently at high levels, those that improved and those that worsened. A significant correlation (Spearman's r=0.70; p<0.05) was observed between the intensity of actions and the degree of improvement. Overall HCQS values were similar to those obtained in the Catalan Primary Care accreditation model.

After four years, the HCQS model for OMIC outpatient centres has proved feasible, flexible and well accepted by professionals, and useful for structuring the evaluation of quality of care.