LAUSR

OBJECTIVES to develop a system of indicators to monitor the quality of health care, in terms of safety, effectiveness, and appropriateness to allow the integrated promotion of the welfare of the effectiveness and quality. DESIGN retrospective study. SETTING AND PARTICIPANTS all general practitioners (GPs) with at least 100 patients in loading at 1.1.2015 were included. The setting chosen is the Primary Care of the Agency for Health Protection of the Province of Milan (Northern Italy). MAIN OUTCOME MEASURES for each GPs 39 indicators were calculated, including 7 on the mix of patients, 4 on prevention, 5 on ER, 5 on hospital admissions, 8 on outpatient, and 10 on pharmaceutical prescription. The correlations between individual indicators were considered and patterns to classify the GPs were determined by the factor analysis and the multiple correspondence analysis. RESULTS among the expected correlations, we observed those between institutional colorectal screening and institutional breast cancer screening. Among not-expected correlations, the one between pump-inhibitor drugs and routines blood chemistry in the population between 20 and 50 years identifies a positive association between two practices of unrecognized clinical validity. Classifying the 2,217 GPs on the basis of the maximum factorial score, six main factors were identified. CONCLUSION using approaches based on multivariate methods, interventions aimed at changing the profile of MMG exerting the government primary health care can be proposed, not only by means of system rules or approaches based on economic incentives, but on complex governance mechanisms.