liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Medical audit used for estimation of optimum level of outpatient care
The Primary Health Care Centre of Habo, Sweden.
Medical Department, Falköping Hospital, Sweden.
Department of Primary Health Care, Gothenburg University, Sweden.
1995 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 13, no 3, 175-181 p.Article in journal (Refereed) Published
Abstract [en]

Objective - To create a model for determining the optimum level of outpatient medical care and to determine this level.

Design - Expert committees were established comprising one or two hospital physicians and two general practitioners who checked medical records for all outpatient visits to doctors made by a defined population during a defined period of time. the determination of optimum level was made blindly by each member of the expert committee.

Setting and participants - the study comprised all visits to physicians during 10 weeks, in total more than 4000, made by the people in a Swedish community, of which 2084 were randomized.

Results - Total agreement between the members of the committee was initially reached for 84% of the visits and, after a common discussion between the committee members, for 99%. A general practitioner was considered to be the optimum level of care for 76% of the patients in the total series, in the upper ages (above 80) for about 85%.

Conclusion - This method seemed suitable for determining the optimum level of care in a population and may be of value when planning for an optimum health care service. Based on the results from our study it seems reasonable to assume that general practitioners whose training corresponds to that of Swedish ones are competent to treat about 75% of all consultations.

Place, publisher, year, edition, pages
Informa Healthcare, 1995. Vol. 13, no 3, 175-181 p.
Keyword [en]
medical audit, level of care, outpatient care, primary health care
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-81481DOI: 10.3109/02813439508996758OAI: diva2:552921
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2012-09-25Bibliographically approved
In thesis
1. Methods for quality development on the primary health care structure
Open this publication in new window or tab >>Methods for quality development on the primary health care structure
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe and analyse methods for quality development of the Swedish primary health care structure. Specific aims were as follows. To describe and test a medical-audit method of determining the optimum level of outpatient medical care. To describe and test the tracer-condition methodology for quality assessment of the medical care delivered by the primary health care. To describe and test a practice-visiting method to compare the total qualities of primary health care centres in order to facilitate quality improvement. To describe and test Donabedian's method (structure, process, outcome) of evaluating a health-promotion programme giving special attention to outcome. To use register data as a method to analyse important determinants of hospitalisation rates and whether the primary health care has any influence.

Different methods for quality development, such as peer review, medical audit, practice-visiting and tracer-condition technique, were used in order to evaluate the quality of care at the primary health care centres and to identify the role of primary health care in the total health care system. Papers I-V were based on studies of everyday activities in ordinary health care centres and hospitals in three counties in southern Sweden during 1987-2000.The methods used were chosen and adapted for the purpose of the studies.

It was agreed upon that about 75% of the outpatient visits to a doctor could be managed by a general practitioner (GP) (Paper I). There was no difference in quality when patients with insulin-treated diabetes mellitus visiting a GP were compared with those visiting a doctor at a hospital (Paper II). Practice-visiting proved to be a suitable method of comparing different primary health care centres with respect to medical quality (Paper III). A health promotion progrannne could be integrated into the everyday work at the health centres and was found to improve lifestyle habits and influence cardiovascular risk factors (Paper IV). The most important determinants of hospitalisation rates were age, the proportion of the population born abroad, the structure of the health care organisation, and the number of outpatient visits to hospital (Paper V).

The different methods which have been described need to be adapted to Swedish primary health care. The methods described in this thesis (medical audit, the tracer-condition method, practice-visiting and Donabedian's method) were usable for the purposes described. Register studies yielded valuable information in analysing important factors for explaining hospitalisations.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 65 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 719
Quality development, primary health care, evaluation, medical audit, tracercondition method, practice-visiting, health promotion, register study
National Category
Social Sciences
urn:nbn:se:liu:diva-26342 (URN)10866 (Local ID)91-7373-161-7 (ISBN)10866 (Archive number)10866 (OAI)
Public defence
2002-07-01, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-17Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Lindström, Kjell
In the same journal
Scandinavian Journal of Primary Health Care
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 40 hits
ReferencesLink to record
Permanent link

Direct link