Validation of an international infrastructure and management set of quality indicators for Israeli primary care

BACKGROUND: Adequate premises, equipment and organization of care are prerequisites for good primary care. The lack of a generally accepted systematic framework for practice management contributes to clinical outcome variations as well as inequalities in health care delivery. OBJECTIVE: To validate, localize and assess an internationally validated method for practice assessment in primary care in Israel. METHODS: The international tool contained 6 domains, 171 indicators and 470 items in 32 different aspects of primary health care provision. The instrument was translated into Hebrew. The major assessment in Israel was performed in 30 practices of Clalit Health Services by practice visits of 2 independent observers who completed check lists, structured interviews with the management staff of the clinic, work satisfaction questionnaires of the clinic staff and satisfaction questionnaires to patients at 30 clinics. The data was processed and analysed by SPSS. Frequency distribution and descriptive statistics were computed for all questions. Factor and reliability analysis were used to reduce the remaining items to a reduced number of indicators. OUTCOMES: From the initial 171 indicators and 470 items, we have managed to downsize the process of evaluation to a feasible size of 57 indicators and 142 items which have been proved as discriminating between the practices on an international level. The Israeli assessment downsized the number of locally discriminating indicators to 50. CONCLUSIONS/RECOMMENDATIONS: The resulting set of indicators is good and valid for improving the organization and management of general practices. On a national Israeli level there is need for further validation, which will include all the Israeli providers.