Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Development of a monitoring instrument to assess the performance of the Swiss primary care system

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

The Swiss health system is customer-driven with fee-for-service paiement scheme and universal coverage. It is highly performing but expensive and health information systems are scarcely implemented. The Swiss Primary Care Active Monitoring (SPAM) program aims to develop an instrument able to describe the performance and effectiveness of the Swiss PC system.

Methods

Based on a Literature review we developed a conceptual framework and selected indicators according to their ability to reflect the Swiss PC system. A two round modified RAND method with 24 inter−/national experts took place to select primary/secondary indicators (validity, clarity, agreement). A limited set of priority indicators was selected (importance, priority) in a third round.

Results

A conceptual framework covering three domains (structure, process, outcome) subdivided into twelve sections (funding, access, organisation/ workflow of resources, (Para-)Medical training, management of knowledge, clinical−/interpersonal care, health status, satisfaction of PC providers/ consumers, equity) was generated.
365 indicators were pre-selected and 335 were finally retained. 56 were kept as priority indicators.- Among the remaining, 199 were identified as primary and 80 as secondary indicators. All domains and sections are represented.

Conclusion

The development of the SPAM program allowed the construction of a consensual instrument in a traditionally unregulated health system through a modified RAND method. The selected 56 priority indicators render the SPAM instrument a comprehensive tool supporting a better understanding of the Swiss PC system’s performance and effectiveness as well as in identifying potential ways to improve quality of care. Further challenges will be to update indicators regularly and to assess validity and sensitivity-to-change over time.
Appendix
Available only for authorised users
Literature
1.
OECD/WHO. OECD Reviews of Health Systems. Switzerland: OECD publishing; 2011.
2.
Petrini LS. I., Erfahrungen der Allgemeinbevölkerung im Gesundheitssystem: Situation in der Schweiz und internationaler Vergleich. OBSAN Dossier. 2013;26:26.
3.
Herzlinger RE, Parsa-Parsi R. Consumer-driven health care: lessons from Switzerland. JAMA. 2004;292(10):1213–20.CrossRefPubMed
4.
Senn N. Le programme SPAM: développement d'un outil pour investiguer le fonctionnement de la médecine de premier recours. Revue Médicale Suisse. 2013;9:19–21.
5.
Davis. K.e.a. Mirror: Mirror on the wall; 2014. p. 1755.
6.
7.
Donabedian AV. 1. Ann Arbor: Health Administration Press; 1980.
8.
Nivel, Raw data of the Phameu Study (online). 2014.
9.
10.
Engels Y, et al. Testing a European set of indicators for the evaluation of the management of primary care practices. Fam Pract. 2006;23(1):137–47.CrossRefPubMed
11.
van der Ploeg E, et al. Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands. Qual Saf Health Care. 2008;17(4):291–5.CrossRefPubMed
12.
WHO, Health Systems Strengthening Glossary. 2011.
13.
14.
15.
OFSP, Situation actuelle de la médecine de premier recours. Rapport du Conseil fédéral en exécution du postulat de la sécurité sociale et de la santé publique du Conseil des Etats (CSSS- CE) 07 3279. Revalorisation de la médecine de famille » ainsi que du postulat de même teneur de la Commission de la sécurité sociale et de la santé publique du Conseil national (CSSS-CN) 07.356, 2010.
16.
Suisse, C.f., Rapport explicatif sur le contre-projet direct à l'initiative populaire "Oui à la médecine de famille",. 2011.
17.
K., K., Grundversorgungsmedizin »in der Schweiz; Bureau BASS im Auftrag des Bundesamt für Gesundheit.. 2005(Bericht Nr 15).
18.
Dubach P., K.K., Tätigkeitstruktur der Ärzte/innen mit Praxistätigkeit - Wer erbringt welche Leistungen in der Grundversorgung? Eine Analyse von TARMED-Daten, Bureau BASS, OFSP. 2008.
19.
20.
Donaldson MS, Vanselow NA. The nature of primary care. J Fam Pract. 1996;42(2):113–6.PubMed
21.
S. Vilpert, O., Médecins de premier recours – Situation en Suisse et comparaison internationale. OBSAN, 2012. Obsan Dossier 22.
22.
23.
Timbie J, et al. A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties. BMC Medical Informatics and Decision Making. 2012;12(1):93.CrossRefPubMedPubMedCentral
24.
Dalkey, N.C., The DELPHI METHOD: An experimental study of group opinion. Memorandum of the RAND Corporation, 1969(RM-5888_PR).
25.
Ruiz-Canela-Caceres J, et al. Indicators for childhood asthma in Spain, using the Rand method. Allergol Immunopathol. 2015;43(2):147-56.
26.
27.
28.
29.
30.
deVellis, R., Scale development: theory and applications (applied social research methods) 4th edition. 2017.
31.
32.
Selby K, Cornuz J, Senn N. Establishment of a representative practice-based research network (PBRN) for the monitoring of primary Care in Switzerland. The Journal of the American Board of Family Medicine. 2015;28(5):673–5.CrossRefPubMed
33.
Giller B, et al. Optimizing comparisons of PHC systems: an example comparing Switzerland and France with a standard monitoring tool. Praxis (Bern 1994). 2017;106(7):373–9.CrossRef
34.
Pierson P. Increasing returns, path dependence and the study of politics. American Political Science Review. 2000;94:251–67.CrossRef
35.
Senn N, Ebert ST, Palan P, Fischer R, Cornuz, .J. SPAM Network of family physicians: towards a better understanding of primary care in Switzerland. Oral presentation, annual conference of the north American primary care researcher Group. 2013;
36.
Rosemann T, et al. Utilisation of information technologies in ambulatory care in Switzerland. Swiss Med Wkly. 2010;140:w13088.PubMed
Metadata
Title
Development of a monitoring instrument to assess the performance of the Swiss primary care system
Publication date
01-12-2017
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2696-z

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Study protocol

Practising proportionate universalism – a study protocol of an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden

Study protocol

Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study

Research article

The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain- a longitudinal study

Research article

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

Research article

Explaining culturally and linguistically diverse (CALD) parents’ access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the ‘Watch Me Grow’ study

Research article

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield