Clinical governance in primary care groups: the feasibility of deriving evidence-based performance indicators

Objectives-To test the feasibility of deriving comparative indicators in al l the practices within a primary care group. Design-A retrospective audit using practice computer systems and random not e review. Setting-A primary care group in southern England. Subjects-All 18 general practices in a primary care group. Main outcome measures-Twenty six evidence-based process indicators includin g aspirin therapy in high risk patients, detection and control of hypertens ion, smoking cessation advice, treatment of heart failure, raised cholester ol levels in those with established cardiovascular disease, and the treatme nt of atrial fibrillation. Feasibility was tested by examining whether it w as possible to derive these indicators in all the practices; the problems a nd constraints incurred when collecting data; the variations in indicator v alues between practices in both their identification of diseases and in the uptake of various interventions; the possible reasons for these variations ; and the cost of generating such indicators. Results-It was possible to derive eight indicators in all practices and in three practices all 26 indicators. The median number of indicators derived was 12 with two practices able to generate eight. There was considerable va riation in the use of computers between practices and in the ability and ea se of various practice computer systems to generate indicators. Practices v aried greatly in the identification of diseases and in the uptake of effect ive interventions. Variation in identification of ischaemic heart disease c ould not be explained by a higher prevalence in practices with a more depri ved population. The cost of generating these indicators was pound 5300. Conclusion-Comparative evidence-based indicators, used as part of clinical governance in primary care groups, could have the potential to turn evidenc e into everyday practice, to improve the quality of patient care, and to ha ve an impact on the population's health. However, to derive such indicators and to be able to make meaningful comparisons primary care groups need gre ater conformity and compatibility of computer systems, improved computer sk ills for practice staff, and appropriate funding.