Testing a European set of indicators for the evaluation of the management of primary care practices

Fam Pract. 2006 Feb;23(1):137-47. doi: 10.1093/fampra/cmi091. Epub 2005 Oct 21.


Background: Effective practice management is an important prerequisite for offering good clinical care. Internationally valid, reliable and feasible indicators and instruments are needed to describe and compare the management of primary care practices in Europe.

Objective: This paper describes development and evaluation of the European Practice Assessment instrument and indicators (Engels Y, Campbell S, Dautzenberg M et al. Developing a framework of, and quality indicators for, general practice management in Europe. Fam Pract 2005; 22(2): 215-22).

Methods: The study design was a validation and feasibility study set in 273 general practices in Austria, Belgium, France, Germany, Israel, The Netherlands, Slovenia, Switzerland and the UK. Use was made of a set of 62 valid quality indicators derived previously from an international Delphi procedure. The EPA instrument, based on this set of indicators, was used to collect data in the 273 practices. This instrument consists of self-completed questionnaires for doctors, staff managers and patients. In addition, there is an interview schedule for use by an outreach visitor, to be held with the lead GP or manager, and a visitor checklist. The instrument was analysed using expert review by the project partners, factor and reliability analyses, ANOVA analyses and by determining intraclass correlations.

Results: Fifty-seven indicators were found to be valid, feasible, reliable and discriminative in all participating countries. The instrument was able to determine differences in practice management within and between countries. All (but one) practices completed the assessment procedure. The data collection method appeared to be feasible, although some aspects can be improved.

Conclusion: The EPA instrument provides feedback to practices that facilitates quality improvement and can compare primary care practices on a national and an international level.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Europe
  • Female
  • Humans
  • Male
  • Practice Management, Medical / standards*
  • Primary Health Care / organization & administration*
  • Quality Assurance, Health Care / methods*
  • Quality Indicators, Health Care / standards*
  • Risk Factors
  • Total Quality Management