Challenges of audit of care on clinical quality indicators for hypertension and type 2 diabetes across four European countries.

Background. The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. Methods. Two common c hronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records. Results. Although it was agreed to obtain the clinical indicator s in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients’ data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators. Conclusions. Measurement of clinical performance in PC by audit is methodologically challenging: dif ferent databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured.