Article Text

Download PDFPDF
Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands
  1. E van der Ploeg1,2,
  2. M F I A Depla2,
  3. P Shekelle3,
  4. H Rigter1,
  5. J P Mackenbach1
  1. 1
    Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2
    Program on Aging, Trimbos-Instituut, Netherlands Institute on Mental Health and Addiction, Utrecht, The Netherlands
  3. 3
    RAND Health, Santa Monica, California, USA
  1. Miss E van der Ploeg, Trimbos-Instituut, Program on Aging, PO Box 725, 3500 AS Utrecht, The Netherlands; eploeg{at}


Background: Measurement of the quality of healthcare is a first step for quality improvement. To measure quality of healthcare, a set of quality indicators is needed. We describe the adaptation of a set of systematically developed US quality indicators for healthcare for vulnerable elders in The Netherlands. We also compare the US and the Dutch set to see if quality indicators can be transferred between countries, as has been done in two studies in the UK, with mixed results.

Method: 108 US quality indicators on GP care for vulnerable elders, covering eight conditions, were assessed by a panel of nine clinical experts in The Netherlands. A modified version of the RAND/UCLA appropriateness method was used. The panel members received US literature reviews, extended with more recent and Dutch literature, summarising the evidence for each quality indicator.

Results: 72 indicators (67% of US set) were (nearly) identical in the Dutch and US sets. For some conditions, this percentage was much lower. For undernutrition, only half of the US indicators were included in the Dutch set. For depression, many indicators were discarded or changed in a significant way, with the result that only five of the original 17 indicators (29%) are the same in the Dutch and the US set.

Conclusions: Quality indicators can be transferred between countries, but with caution, because in two of the three studies on transferring indicators between the US and Europe, 33–44% of the indicators were discarded. For some conditions in the current study, this percentage is much higher. For undernutrition, there is hardly any evidence, and differences between the indicator sets can be attributed to differences in expert opinion between the countries. For depression, it seems that different evidence is considered important in the US and in The Netherlands, of which the Dutch body of knowledge is not known in the US.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: This study was financed by The Netherlands Organization for Health Research and Development (ZonMw), PO Box 93 245, 2509AE, Den Haag, The Netherlands.

  • Competing interests: None.

  • Ethics approval: Ethics approval was obtained.