Aim: To estimate the comparability and discriminability of outcome-based quality indicators by performing a practice test in Dutch physical therapy primary care, and to select a core set of outcome-based quality indicators that are well accepted by physical therapists based on their perceived added value as a quality improvement tool.
Methods: First, a list of potential quality indicators was defined, followed by determination of the comparability (case-mix adjusted multilevel analysis) and discriminability (intraclass correlation coefficient (ICC)). Second, focus group meetings were conducted with stakeholders ( physical therapists and senior researchers) to select a core set of quality indicators.
Results: Overall, 229 physical therapists from 137 practices provided 2651 treatment episodes.
Comparability: in 10 of the 11 case-mix adjusted models, the ICC increased compared with the interceptonly model. Discriminability: the ICC ranged between 0.01 and 0.34, with five of the 11 ICCs being >0.10. The majority of physical therapists in each focus group preferred the inclusion of seven quality indicators in the core set, including three process and four outcome indicators based upon the 6-min walk test (6MWT), the Clinical COPD Questionnaire (CCQ), and the determination of quadriceps strength using a hand-held dynamometer.
Conclusion: This is the first study to describe the comparability and discriminability of the outcome-based quality indicators selected for patients with COPD treated in primary care physical therapy practices. Future research should focus on increasing data collection in daily practice and on the development of tangible methods to use as the core set of a quality improvement tool.
The aim was is to estimate the comparability and discriminability of outcome-based quality indicators by performing a practice test in Dutch physical therapy primary care, and to select a core set of outcome-based quality indicators that are well accepted by physical therapists based on their perceived added value as a quality improvement tool.
ContributorsArie C. Verburg, Simone A. van Dulmen, Henri Kiers, Maria W.G. Nijhuis-van der Sanden, and
Philip J. van der Wees
Disease Category: Lungs & airways
Disease Name: Chronic obstructive pulmonary disease (COPD)
Age Range: Unknown
Sex: Either
Nature of Intervention: Physical
- Clinical experts
- Consumers (patients)
- Researchers
- Core indicator set
- Focus group(s)
- Interview
In phase 1 of the present study, potential quality indicators were defined, and we estimated their comparability and discriminability with prospectively collected cohort data between February 2018 and December 2019. To enhance the comparability, we adjusted for differences in patient characteristics using a case-mix correction. Furthermore, we calculated whether the quality indicator was able to discriminate the outcomes of patients between practices and could therefore be used as an instrument for quality improvement. In
phase 2, we explored the perceived added value of the indicators in focus group meetings with physical therapists. We then actively involved participants in the selection of a core set of quality indicators.