Measurement of quality improvement in family practice over two-year period using electronic database quality indicators: Retrospective cohort study from Israel

Aim To investigate the associations between family physicians' characteristics and the change in quality of health care indicators (QI) over a two-year period. Methods The retrospective cohort study included 161 (60.5%) of 266 family physicians who worked for the Clalit health fund in Israel in the period from January 2003 until December 2005. Family physicians' background characteristics included seniority, location of the clinic (urban or rural), workload, sex, managerial responsibilities, and board certifcation. The performance in 11 QIs, including indicators of diabetes follow-up (n = 4) and control (n = 2), hospitalization for chronic obstructive pulmonary disease and congestive heart failure (n = 2), and preventive medicine measures (infuenza immunization for high risk patients and mammography) was evaluated at the end of 2003 and 2005. Results There was an improvement in all the QIs except mammography. The improvement was signifcant for 8/10 QIs, the greatest being in achieving low-density lipoprotein cholesterol (+18.2%) and HbA1c (+5.9%) targets in diabetic patients. Multivariate regression model showed that the most signifcant factor associated with better QIs in December 2003 was board certifcation, while 2 years later it was female sex and having a managerial position. Being a board-certifed physician remained positively associated with high QIs for diabetes control. Conclusion There was an improvement in most QIs in the period of 2 years. Initially, board certifcation was signifcantly associated with high QIs, but clinic managers and female physicians showed the ability to improve their scores. Research should continue to fnd ways to make all physicians responsive to their QIs.