Electronisch feedbacksysteem voor huisartsen. Een kwaliteitsverbetering?

Bossink E, Corten A. Electronic feedback system for GPs: An opportunity for quality improvement? Nijmegen: IQ healthcare; 2009.

In Nederland wordt de huisartsenzorg buiten kantooruren verzorgd door huisartsenposten. Het krijgen van feedback van de eigen huisarts van de patiënt is belangrijk voor de dienstdoende huisarts op de huisartsenpost. Hiertoe is een electronisch feedback systeem ontwikkeld wat gebruikt wordt op diverse huisartsenposten.

Objective:
To develop a reliable measuring instrument for categorizing the feedback information. To investigate which aspects of health care the feedback is about, are there learning objectives? Also to study the feedback about patients who died unexpectedly and their characteristics.

Methods:
Cross sectional pilot study of patient files of one GP cooperative and the matching feedback given by the patient's own GP. A classification system was constructed to categorize all feedback information. Of the 46,542 patients who visited the GP cooperative, GPs gave feedback in 3,659 (7.9%) cases. Of these 3,659 cases, the 999 most recent were studied. Two observers categorized 500 cases each. An International Classification of Primary Care (ICPC) code was used to label the diagnosis. The feedback with learning objectives and information about patients who died unexpectedly was discussed by three observers and further categorized.

Results:
We developed a classification system, which was tested for the inter-observer variability and gave an average Kappa value of 0.86. Of the 999 feedback cases 69.9% were about diagnosis, 27.7% about the patient's disease course and 19.0% about hospitalization. Of the feedback 1.0% was about organisation and 0.7% about communicational aspects. Of the patients with chest pain, suspected for heart disease, only one third actually had a myocardial infarction. Retrospectively some of these patients with a myocardial infarction had not been referred immediately by the GPC. Out of 999 feedback cases, there were 7 unexpected deaths, which were possibly avoidable by the GP of the cooperative (GPC). These cases were mostly elderly patients with acute cardiovascular diseases. Of the 999 cases, 5.3% contained an explicit opinion with an obvious learning objective. Cases with a learning objective concern mainly accessibility to the patient's records, inadequate triage due to improper questioning of the patient, lacking of a physical examination and doctor's delay.

Conclusion:
A reliable measuring instrument was developed for categorizing this feedback data and the developing process guaranteed a high face and content validity. Compared to the large amount of feedback about diagnosis, there was a low percentage about communication and organisation. Possibly avoidable deaths and learning objectives concerned mostly elderly patients with acute cardiovascular diseases. The feedback program is a promising initiative, but still needs some adjustments.

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