Definitions of the selected quality indicators.

BackgroundChronic conditions are a significant public health concern due to their rising prevalence, association with high mortality, and substantial healthcare costs. General practitioners play a crucial role in managing these conditions, and quality indicators are essential tools for assessing the quality of care. Electronic feedback reports incorporating quality indicator performance have shown promise in improving care quality. However, most studies have focused on single conditions or link feedback to financial incentives, which may not sustain long-term practice changes. This study aims to evaluate the effectiveness of a multi-condition electronic feedback reports on quality indicator performance in Swiss general practice without financial incentives.MethodsThis randomized controlled trial involves general practitioners enrolled in the FIRE project, a database of electronic medical records from Swiss primary care. Participants are randomized to receive either a plain feedback report or a comprehensive quality indicator -specific feedback report bi-monthly for 12 months. The plain feedback report contains descriptive summaries of practice activities, while the quality indicator-specific feedback report includes performance data on 14 quality indicators across cardiovascular, endocrine, pulmonary, and renal domains. The quality indicators were selected in multi-step process involving review of the literature and clinical guidelines, domain expert consultations, and a panel discussion with general practitioners. The primary study objective is to compare the effectiveness of the quality indicator-specific feedback report and of the plain feedback report with respect to the performance of the selected quality indicators.ConclusionThe study addresses a critical gap by evaluating a multi-condition feedback report without financial incentives. Its findings can inform future health policies and strategies, in line with national and international initiatives that promote or even require the implementation of quality measurement activities in general practice.Trial registrationTrial registry: ISRCTN. Registration number: ISRCTN10637092, https://www.isrctn.com/ISRCTN10637092. Registered January 9, 2024.研究背景 慢性疾病（Chronic conditions）因患病率持续攀升、与高死亡率相关且医疗成本高昂，已成为重大公共卫生关切。全科医师（General practitioners）在这类疾病的管理中发挥着关键作用，而质量指标（quality indicators）则是评估医疗服务质量的核心工具。整合质量指标绩效的电子反馈报告（electronic feedback reports），在提升医疗质量方面已展现出应用前景。然而，现有多数研究仅聚焦于单一疾病，或是将反馈与经济激励挂钩，此类模式或难以维持长期的临床实践变革。本研究旨在评估针对多种疾病的电子反馈报告，在无经济激励的瑞士全科医疗场景中对质量指标绩效的改善效果。 研究方法 本项随机对照试验（randomized controlled trial）的研究对象为参与FIRE项目的全科医师，该项目数据库涵盖瑞士基层医疗的电子病历（electronic medical records）数据。研究参与者被随机分为两组，在12个月内每两个月分别接收简易反馈报告，或是针对特定质量指标的综合反馈报告。其中，简易反馈报告仅包含诊疗活动的描述性汇总内容；而针对特定质量指标的反馈报告，则涵盖了心血管、内分泌、呼吸及肾脏领域共14项质量指标的绩效数据。这些质量指标通过多步骤流程遴选完成：包括文献与临床指南审查、领域专家咨询，以及与全科医师开展的专题小组讨论（panel discussion）。本研究的主要目标是对比特定质量指标反馈报告与简易反馈报告在提升选定质量指标绩效方面的有效性。 研究结论 本研究通过评估无经济激励的多疾病反馈报告，填补了相关领域的关键空白。其研究结果可为未来的卫生政策与策略制定提供参考，契合当前国内外旨在推动甚至强制要求在全科医疗中开展质量衡量活动的相关举措。 试验注册 试验注册平台：ISRCTN。注册编号：ISRCTN10637092，https://www.isrctn.com/ISRCTN10637092。注册日期：2024年1月9日。