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Abstract：
Quality improvement is now a central tenet in physiotherapy care, and quality indicators (QIs), as measurable elements of care, have been applied to analyze and evaluate the quality of physiotherapy care over the past two decades. QIs, based on Donabedian\'s model of quality of care, provide a foundation for measuring (improvements in) quality of physiotherapy care, providing insight into the many remaining evidentiary gaps concerning diagnostics, prognostics and treatment, as well as patient-related outcome measures. In this overview we provide a synthesis of four recently published articles from our project group on the topic of quantitative measures of quality improvement in physiotherapy care, in this context specifically focused on patients with WAD in primary care physiotherapy. A set of process and outcome QIs (n = 28) was developed for patients with WAD and linked to a database consisting of routinely collected data (RCD) on patients with WAD collected over a 16-year period. The QIs were then embedded per step of the clinical reasoning process: (a) administration (n = 2); (b) history taking (n = 7); (c) objectives of examination (n = 1); (d) clinical examination (n = 5); (e) analysis and conclusion (n = 1); (f) treatment plan (n = 3); (g) treatment (n = 2); (h) evaluation (n = 5); and (i) discharge (n = 2). QIs were expressed as percentages, allowing target performance levels to be defined ≥70% or ≤30%, depending on whether the desired performance required an initially high or low QI score. Using RCD data on primary care patients with WAD (N = 810) and a set of QIs, we found that the quality of physiotherapy care has improved substantially over a 16-year period. This conclusion was based on QIs meeting predetermined performance targets of ≥70% or ≤30%. Twenty-three indicators met the target criterium of ≥70% and three indicators ≤30%. Our recommended set of QIs, embedded in a clinical reasoning process for patients with WAD, can now be used as a basis for the development of a validated QI set that effectively measures quality (improvement) of primary care physiotherapy in patients with WAD.
摘要：
质量改善现在是物理治疗护理的核心原则，和质量指标(QIs)，作为可衡量的护理要素，在过去的二十年中，已用于分析和评估理疗护理的质量。QIs,基于Donabedian的护理质量模型，为测量（改善）理疗护理质量提供基础，提供有关诊断的许多剩余证据空白的见解，预后和治疗,以及与患者相关的结果指标。在此概述中，我们提供了我们项目组最近发表的四篇关于物理治疗护理质量改进的定量措施的综合文章，在这种情况下，特别关注WAD患者的初级保健理疗。为WAD患者开发了一组过程和结果QI（n=28），并与由16年期间收集的WAD患者的常规收集数据（RCD）组成的数据库相关联。然后在临床推理过程的每个步骤中嵌入QI：（a）给药（n=2）；（b）病史记录（n=7）；（c）检查目标（n=1）；（d）临床检查（n=5）；（e）分析和结论（n=1）；（f）治疗计划（n=3）；（g）治疗（n=2）；（h）评估（n=5）QI以百分比表示，允许将目标性能水平定义为≥70%或≤30%，取决于所需的性能是否需要最初的高或低QI分数。使用患有WAD（N=810）的初级保健患者的RCD数据和一组QI，我们发现,在16年的时间里,理疗护理的质量有了显著的改善.该结论基于满足≥70%或≤30%的预定绩效目标的QI。23项指标满足≥70%目标标准,3项指标≤30%。我们推荐的质量指标集，嵌入到WAD患者的临床推理过程中，现在可以用作开发经过验证的QI集的基础，该QI集可以有效地测量WAD患者的初级护理物理治疗的质量（改善）。
