Abstract

The Dutch Healthcare Inspectorate is in search for a better insight into the quality of care for heart failure patients. This report proposes a set of so-called indicators that enable monitoring of the quality of care. A patient being treated is often faced with doctors of various specialties, different medical and paramedical personnel and other caregivers, both within and outside the hospital. This multidisciplinary setting requires good coordination. Such 'chain care' therefore makes high demands on communication and transfer of information between caregivers. Also a clear demarcation of responsibilities is essential. The extent to which such requirements are met constitutes an indicator of the quality of care delivered. In addition, patients' experiences are an important source of information for putting the quality of care to the test.
The study reported here was conducted by the National Institute for Public Health and the Environment in collaboration with the Health Inspectorate and may serve as a first step in the development of a concrete set of indicators.
In order to be able to identify suitable indicators, first the heart failure care chain was charted in the form of a schematic model. This chain model (a 'clinical logic') captures the elements of the disease process and the care chain to which it gives rise. Next, the components of the model and the interactions and factors that seem to determine the quality of care were described in an analytical manner. On the basis of the worked out model fifteen potential indicators were proposed. The central purpose was to identify indicators that provide insight into the performance of the chain as a whole.