Developing a 'consultation quality index' (CQI) for use in general practice

Background. The core values of general practice include holism and patient- centredness. None of the measures of quality of care in general practice pr esently capture the expression of these values at routine consultations. Objectives. The aim of the present study was to construct a 'consultation q uality index' (CQI) which reflects the core values of general practice, usi ng as proxies 'consultation length' and how well patients 'know the doctor' as process measures and 'patient enablement' as an outcome measure. Methods. The CQI was constructed from data collected from 23 799 adult Engl ish-speaking patients consulting 221 doctors in four demographically contra sting areas of the UK during 2 weeks of March/April 1998. A total of 171 do ctors who entered 50 qualifying consultations were allocated scores for the three component variables, and a total CQI was calculated. Results. CQI scores were in the range 4-18. Validity was examined by lookin g at high and low scorers in greater detail and by searching for correlates with case mix, patient age and gender, and the deprivation scores of the p ractices concerned. Particular attention was paid to how registrars and doc tors new to their practices scored. The scores of different doctors in the same practice were also noted. The results had strong face validity and wer e independent of case mix and deprivation. Reliability was gauged by examin ing similar work from a previous study which had collected information on c onsultation length and enablement over three time periods. High CQI scores were associated with smaller overall practice list sizes. Conclusions. We have outlined possible uses for the CQI as part of the pack ages assessing quality of care by doctors and practices. The measure may al so have a part to play in recognizing poorly performing doctors. We suggest how CQI scores could contribute to an incentive scheme to reward good cons ulting practice. Further work is in hand to compare doctors' CQI scores wit h scores based on performance indicators constructed from routine NHS data on prescribing and preventive medicine.