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Abstract
Background Prevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.
Methods We conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.
Results We created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.
Conclusion We show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.
Trial registration number German clinical trials registry (DRKS00015718), Pre-Results.
- quality in healthcare
- qualitative research
- primary care
- public health
Data availability statement
No data are available. The data generated and analysed during the current study are not publicly available due to the study’s assurances to participants that the full raw focus group data would not be shared publicly, and that all attempts would be made to maintain confidentiality. We named the people who are responsible for data analysis to the focus group participants in the written consent and they did not agree with the sharing of the full raw data.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
No data are available. The data generated and analysed during the current study are not publicly available due to the study’s assurances to participants that the full raw focus group data would not be shared publicly, and that all attempts would be made to maintain confidentiality. We named the people who are responsible for data analysis to the focus group participants in the written consent and they did not agree with the sharing of the full raw data.
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Footnotes
Twitter @degampraesident
Contributors MS, DL and JSz—acquisition of funding for and conception, design and supervision of the study. AB, KG, NJP and JSc—moderation of focus groups. AB, KG, CH, NJP and JSc—data analysis and interpretation. NJP—drafting of the manuscript. AB, KG, CH, DL, JSc, JSz and MS—critical revision of former versions and final approval of the manuscript.
Funding This work was supported by the Innovation Fund of the Federal Joint Committee (G-BA; grant no. 01VSF16058).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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