چکیده (انگلیسی):

Background:Practice accreditation is a widely used method to assess and improve the quality of healthcare services.
In the Netherlands, a practice accreditation program was implemented in primary medical care. We aimed to identify
determinants of impact of a practice accreditation program, building on the experiences of primary care professionals
who had participated in this program.
Methods:An interview study was done to document the experiences of 33 participating primary care professionals
and used to identify determinants of outcomes. The Consolidated Framework for Implementation Research (CFIR) was
used as framework for the qualitative analysis.
Results:After analyzing 23 interviews saturation was reached. The practice accreditation program is based on
structured quality improvement, but only some of its elements were identified as determinants of impact. Factors that
were perceived to facilitate implementation of the program were: designating one person responsible for the program,
ensuring clear lines of communication within the whole practice team and having affinity with or stimulate enthusiasm
for improving quality of care. Contextual factors such as participation in a care group and being connected to the GP
educational institute were important for actual change. The accreditation program was perceived to have positive
effects on team climate and commitment to quality of care in the practice team. The perception was that patient care
was not directly influenced by the accreditation program. Receiving a certificate for completing the accreditation
program seemed to have little added value to participants.
Conclusions:Practice accreditation may have positive outcomes on quality of care, but not all planned elements
may contribute to its outcomes. Both factors in the accreditation process and in the context were perceived as
determinants of quality improvement. The challenge is to build on facilitating factors, while reducing the elements
of accreditation that do not contribute to its impact.