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[Quality improvement in primary care: experience of four years of a quality improvement program]
J Davins i Miralles1, E Avellana i Revuelta, R Marquet Palomer
1Centro de Atención Primaria La Mina, Sant Adrià de Besós, Unitat Docent de Medicina de Familia i Comunitaria, Barcelona.
Objective:
To assess the effectiveness of the quality improvement programme (QIP) at the centre.
Design:
A retrospective analysis of the "improvable situations" detected between 1988 and 1992, their causes and the methods used for their detection. The present status of the improvable situations (solutions) was then studied.
Settings:
La Mina Primary Care Centre.
Patients And Other Participants:
The improvable situations detected from the start of the QIP in March 1989 until December 1992.
Measurements And Main Results:
172 situations were identified, corresponding to 83 different problems, situations or opportunities of improvement. The method which identified the most different and solvable situations (64.5%) was the use of the improvable situation report sheet (problem report) by the professionals at the centre. The component of quality most often affected was accessibility; and the least, satisfaction. The effectiveness component had the highest percentage of situations solved (64.3%) and external problems, the lowest (30%). 62 out of the 180 causes (34.4%) for the 73 improvable situations, which did not affect external aspects of care, were solved. The commonest and most solvable causes were due to lack of internal organisation (64%). 51.8% of the 83 situations detected were solved. There was 73.2% effectiveness of the QIP, measured as a percentage of solved situations, not including those situations with external causes or depending on the user.
Conclusions:
The most useful method of detecting solvable solutions is the use of the improvable situations report sheet by the professional.