Évaluation de la qualité des soins et des services préventifs cardiovasculaires en première ligne

Although cardiovascular diseases (CVD) are one of the leading causes of death worldwide, several studies have shown that cardiovascular prevention is suboptimal in primary care. Changes at clinical, organizational, and legislative levels are currently underway to improve health care quality. However, monitoring quality of care is impossible without reliable and valid indicators. As part of a participatory research program (TRANSIT study) dedicated to improving cardiovascular prevention in primary care, 81 quality indicators (TRANSIT indicators) were developed. To optimize the use of quality indicators in quality improvement strategies, the psychometric properties of the TRANSIT indicators need to be evaluated. Consequently, the objective of the first part of this research program is to assess the reliability and the validity of the TRANSIT indicators. Since medical records are a key source of information to evaluate quality of care, the objective of the second part of this research program is to assess the quality of the documentation of care processes in medical records using the TRANSIT indicators. A psychometric analysis was first conducted using data collected during Phase III of the TRANSIT study. In the first component of the psychometric analysis, the test–retest and inter-rater reliabilities as well as the convergent validity of the indicators were evaluated in a subsample of patients participating in the TRANSIT study (project 1). In the second component of the psychometric analysis, three statistical methods were used to assess the predictive validity of the indicators in the entire population participating in the TRANSIT study (project 2). To assess the quality of the documentation of care processes, levels of compliance to the TRANSIT indicators assessed using medical records were compared with those assessed using patient self-administered questionnaires (project 3). The first research project showed that test–retest and inter-rater reliabilities were excellent except for ten indicators while convergent validity was strong except for domains related to the management of CVD risk factors. Results obtained in the second project suggested that a hybrid method combining multivariate logistic regression and Least Absolute Shrinkage and Selection Operator regression was more efficient than classic statistical methods in identifying process indicators with good predictive validity. Finally, the third research project showed that the quality of cardiovascular disease prevention, as assessed by the TRANSIT indicators, was generally higher when the information was collected using self-administered questionnaires. In conclusion, this research program proposes a series of reliable and valid process indicators that can be used to assess the quality of cardiovascular disease prevention in primary care. Despite the many challenges related to the implementation of measuring instruments in current practice, the development of quality indicators such as the TRANSIT indicators is a first step towards the establishment of a culture of quality improvement and the development of an adequate infrastructure that supports quality assessment activities in our society.

Keyphrases: Quality indicator, Cardiovascular diseases, Prevention, Primary care, Quality improvement