The Effectiveness of a Nationwide Mandatory Accreditation in General Practice in Denmark (ACIAP)
The Effectiveness of a Nationwide Mandatory Accreditation in General Practice in Denmark: A Randomized Controlled Trial
調査の概要
詳細な説明
Accreditation has become a widespread tool for quality control and development, and large resources are spent upon development and implementation of accreditation systems in health care systems all over the world. Accreditation of healthcare systems has met some critique. Evidence for positive effects of accreditation has been called for, and health care professionals have expressed concerns about extra hours imposed by accreditation. However, only few studies have evaluated the effects of accreditation on central items, such as clinical outcomes and patient satisfaction. In general, the results from the different types of studies are ambiguous and there are only few well-accomplished effect studies. Hence, only two effect studies met the methodological inclusion criteria of a recent Cochrane review. None of these studies treated general practice. A review regarding status of accreditation in primary care concluded that there is a dearth of research on the nature and uptake of accreditation in this sector along with how accreditation affects outcomes of care, and whether it is an effective method to improve quality, perceptions of care, healthcare utilisation and costs. Two studies provided evidence to suggest that accreditation status was associated with infection control procedures, risk management programmes and quality improvement activities and after-treatment plans. However, in the latter case, post hoc analysis revealed that accreditation was associated with units' organizational contexts and referral sources as well as the nature of the competitive environment. The authors concluded that accreditation and licensing might reveal as much about a care units' institutional environments as about the quality of treatment provided. Accreditation is a relatively new instrument in general practice and its effects on clinical outcomes, patient satisfaction, general practitioners' (GPs') job satisfaction and organisational aspects must be evaluated in order to assess the overall utility for patients and society. Although accreditation has been implemented in general practice in nine European countries, and in Australia and New Zealand, research elucidating the effects of accreditation in general practice system, is strongly needed. In spite of this lack of evidence for effect of accreditation on clinical and patient related objectives, it has been decided to implement accreditation as a mandatory instrument in Danish general practice.
The Danish Healthcare Quality Programme (DHQP) is based on general principles for accreditation. The model contains a set of accreditation standards as well as an accreditation process. Accreditation has for a longer time period been mandatory in the secondary healthcare system in Denmark, and it has now been decided to include general practice as well. Hence, the DHQP has been adjusted to general practice. DHQP for general practice consists of 16 standards with associated indicators within the following areas: 1. Quality and patient safety, 2. Patient safety critical standards, 3. Good patient continuity of care, 4. Management and organisation. The first practices are accredited in January 2016, and at the end of 2018 all Danish practices should be accredited. An exception is practices with expected termination within 5 years.
Since accreditation is a complex intervention, containing several dimensions and active components, it is of great importance to elucidate these processes and mechanisms that become evident with the roll-out and implementation of accreditation and to examine the possible impact, accreditation may have on health care within primary care.
研究の種類
入学 (予想される)
段階
- 適用できない
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- General practices working under the Danish Health Insurance at June 2014
Exclusion Criteria:
- None
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
アクティブコンパレータ:DHQP 2016
This group consists of general practices allocated to undergo accreditation scheme in 2016.
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DHQP for general practice consists of 16 standards with associated indicators within the following areas: 1. Quality and patient safety, 2. Patient safety critical standards, 3. Good patient continuity of care, 4. Management and organisation.
他の名前:
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プラセボコンパレーター:DHQP 2018
This group consists of general practices allocated to undergo accreditation scheme in 2018.
|
DHQP for general practice consists of 16 standards with associated indicators within the following areas: 1. Quality and patient safety, 2. Patient safety critical standards, 3. Good patient continuity of care, 4. Management and organisation.
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Changes in number of prescribed drugs in patients above 65 years in the observation periods.
時間枠:6 months periods
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Data regarding Prescription medication is retrieved from Nationwide Medication Database (MD)
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6 months periods
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
• Changes in the proportion of polypharmacy patients above 65 years (>5 prescribed drugs) between periods.
時間枠:6 months periods
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More than 5 prescribed drugs based on nationwide Medication Database (MD)
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6 months periods
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• Changes in Daily Drug Dose of NSAID without Proton-pump inhibitor in period between periods.
時間枠:6 months periods
|
Based on nationwide Medication Database (MD)
|
6 months periods
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• Changes in Daily Drug Dose of sleeping medicine between periods.
時間枠:6 month periods
|
Based on nationwide Medication Database (MD)
|
6 month periods
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Changes in the proportion of elderly above 75 receiving a preventive home visit between periods.
時間枠:6 month periods
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The regional practice remuneration system (RPRS)
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6 month periods
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Changes in the number of annual controls for chronic diseases between periods.
時間枠:6 month periods
|
The regional practice remuneration system (RPRS)
|
6 month periods
|
Changes in the number of spirometry between periods
時間枠:6 month periods
|
The regional practice remuneration system (RPRS)
|
6 month periods
|
Changes in proportion of practices with a reported adverse event between periods.
時間枠:6 month periods
|
Danish Patient Security Database (DPSD)
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6 month periods
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Changes in the proportion of practices with a patient satisfaction survey between periods.
時間枠:6 month period
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Danish Patients Evaluation Practice database
|
6 month period
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Changes in mortality rates between periods.
時間枠:2 month periods from index date
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Statistics Denmark
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2 month periods from index date
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協力者と研究者
出版物と役立つリンク
一般刊行物
- Kirstine Andersen M, Pedersen LB, Waldorff FB. Retirement, job satisfaction and attitudes towards mandatory accreditation: a Danish survey study in general practice. BMJ Open. 2018 Aug 13;8(8):e020419. doi: 10.1136/bmjopen-2017-020419.
- Andersen MK, Pedersen LB, Siersma V, Bro F, Reventlow S, Sondergaard J, Kousgaard MB, Waldorff FB. Accreditation in general practice in Denmark: study protocol for a cluster-randomized controlled trial. Trials. 2017 Feb 13;18(1):69. doi: 10.1186/s13063-017-1818-6.
研究記録日
主要日程の研究
研究開始
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
その他の研究ID番号
- NAGEP_RCT01
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
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DHQP 2016の臨床試験
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Central Hospital, Nancy, France完了