1. EPA: EUROPEAN PRACTICE ASSESSMENT Researcher: Yvonne Engels Project leader: Richard Grol Co-ordinator: Maaike Dautzenberg Financed by: Bertelsmann foundation Germany

2. Collaboration Belgium (Flanders), France, Germany, Switzerland, the Netherlands, UK (Wales and England) Bertelsmann Foundation

3. Aim to develop a practice assessment method that assists family/general practitioners in improving their practice performance

4. Methods: 1.Literature review 2.Workshops with partners 3.Consensus procedures - with EPA-partners - Delphi 4.Pilot

5. Good practice management: “Systems (structures and processes) meant to enable the delivery of good quality patient care”

6. Framework 1.Infrastructure 2.Staff 3.Information 4.Finance 5.Quality and safety

7. 170 indicators, e.g.: Domain:INFRASTRUCTURE Dimension:medical equipment Indicator:The emergency bag is complete

8. Modified Rand procedure 170 indicators Translation of the draft set of indicators Delphi procedure Rated by 10 GPs / experts in 6 countries

9. Indicators rated ‘useful’ (of 168) By all countries 62(37%) France103(61%) Germany103(61%) Swiss116(69%) Belgium121(72%) Netherlands125(74%) England/Wales142(85%)

10. Exercise 1 Which indicators do you rate useful? (groups of about 6 persons, preferably from different countries

11. A. Information for patients about clinical care: 0 1.An up-to-date selection of books and videos is available to patients 2.A range of leaflets and brochures is available for patients to read in the practice or to take home 3.Translator services are available on request 4.Information leaflets are available in appropriate languages 5.The practice information sheet is available in appropriate languages

12. B. Non-medical equipment: 4 1.The practice has an operational fax 2.The practice has at least one computer for staff 3.The practice has an internet connection 4.All computers are protected against inappropriate access 5.Every GP has access to e-mail 6.Every GP has access to the internet (www) 7.The practice has a telephone system with sufficient inward and outward capacity 8.The practice has a separate emergency telephone line 9.All electronical medical equipment is checked annually 10.All safety equipment (e.g. fire extinguisher) is checked annually

13. C. Detection of quality and safety problems: 0 1.The practice has undertaken at least one clinical audit in the last year 2.The practice has a critical incident register 3.The practice has a documented process to follow up and analyse critical incidents 4.The practice has a formal consultation process with patients (patient forum or participation group) 5.The practice has a suggestion box for patients 6.The practice has a written patient complaint procedure 7.The written patient complaint procedure is available at the reception

14. D. Working conditions: 2 1.The practice monitors the workload of its staff 2.The practice monitors stress levels of its staff 3.The practice evaluates team working in the organisation 4.The practice has had at least one away day last year 5.Staff experience a pleasant working atmosphere 6.The practice has a policy which enables staff to offer suggestions for improving practice management 7.The practice has written arrangements to ensure the availability of a locum GP when needed

15. The Instrument Short self-administered questionnaires: 1.Representative of the practice 2.individual GPs 3.staff members 4.Patients Observer/facilitator visits the practice: 6.Structured interview with GP/PM 7.Checklist 8.(Maturity Matrix)

16. The pilot Pretest in 3 practices per country September 2003-May 2004: Pilot in 30 practices per country, also in Slovenia, Austria and Israel

17. Result of the pilot Feedback on individual practice level National data International comparisons.

19. Visotool/ Startbildschirm

20. Online-Feedback Basisdaten der Praxis (insgesamt 4 Bildschirmseiten)

22. Ergebnisse/Dimensionen (Bsp. Infrastruktur: Übersicht)

23. Ergebnisse/Dimensionen (Bsp. Infrastruktur: Streudiagramm)

24. To Do list (example)

25. Patient participation (%) complaint procedure Belgium 3 France 3 Germany 25 Netherlands 75 Switzerland 25 UK 100 Slovenia 77 Austria 55

26. Survey patient satisfaction (%) (n) Belgium (31)23 France (17) 3 Germany (32)39 Netherlands (32)38 Switzerland (28)64 UK (27)85 Slovenia (31)53 Austria (33)24

27. Europep GPPractice Belgium (31)9185 France (17)8572 Germany (32)8483 Netherlands (32)8572 Switzerland (28)9190 UK (27)8169 Slovenia (31)9087 Austria (33)9391

28. Leaflets (%) pract. inf. Belgium41 France42 Germany55 Netherlands88 Switzerland48 England 87 Slovenia48 Austria27

29. Medical registration ICPC etc Belgium52 France 24 Germany 100 Netherlands87 Switzerland 29 UK 100 Slovenia 100 Austria 12

30. Patient list (%) Belgium (31) 81 France (29) 0 Germany (32) 0 Netherlands (32)100 Switzerland (28) 74 UK (27)100 Slovenia (31)100 Austria (33) 0

31. System for recalling patients with: AsthmaDiabetesCHD Belgium 65 4232 France 0 0 0 Germany22 4728 Netherlands 62 9150 Switzerland 14 3221 UK 9610096 Slovenia 16 3532 Austria12 2412

32. System for recalling populations at risk: CHD Influenza vacc Belgium 16 42 France 0 0 Germany16 41 Netherlands 56100 Switzerland 7 68 UK 74 96 Slovenia 97 68 Austria 0 0

33. Exercise 2 Discuss in small groups: Do general practices in your country have systems to recall A.patients with specific chronic diseases? Why (not)? B.Populations at risk? Why (not)?

34. What next? Validation of the instrument: (acceptable, feasible, valid, sensitive) Adapted version: next year International data warehouse

35. EPA-book: January 2005 y.engels@wok.umcn.nl www.wokresearch.nl www.aqua-institut.dewww.aqua-institut.de (information Visotool)