Professional Issues and the Quality of Care

This working group has been merged with the Professional Issues WG.
The working group on Quality of Care and Professional Issues signals and investigates professional issues on Internal medicine throughout Europe.
The working group formulates and publishes position papers on behalf of EFIM.”

Active members:

  • Mark H.H. Kramer (chairman) Netherlands
  • Werner Bauer                            Switzerland
  • Monica Bivol                             Norway
  • Dror Dicker                              Israel
  • Mine Durusu Tanriover               Turkey
  • Faustino Ferreira                       Portugal
  • Harry van Hulsteijn                    Netherlands
  • Antonio Martins Baptista             Portugal
  • Narciso Oliveira                         Portugal
  • Shirley Rigby                            United Kingdom
  • Xavier Roux                              France
  • Petra-Maria Schumm-Draeger    Germany
  • Frauke Weidanz                         United Kingdom

Up until now the WG published 4 position papers:

- What is the role of general internists in the tertiary or academic setting?
Political issues internal medicine in Europe  
- The changing face of internal medicine: Patient centred care 

Internal medicine in Europe. How to  cope with the Future? An official EFIM Strategy document  
- What is the role of general internists in the tertiary or academic setting? 

During the last working party meeting on September 26th  in Tartu, Estonia the WG:

1. finalized a position paper on ‘General internal medicine in academia’. It will be submitted for publication in the European Journal of Internal Medicine.
2. Initiated a first draft on ‘Quality standards in Internal medicine’.

The next meeting will be held in April 2015 in Cyprus.


Past Project: EQUIP

Aim:  To improve professional quality of internists.

Slogan:  Quality is the core business of internal medicine as defined by safety, effectiveness, efficiency and patient-centered medical care.


Download the document (PDF format - 33,3 Kb) (PDF)

  • Gold standard for quality in practising internal medicine
  • “Rule of ten”.- Immediate discharge document
  • “Rule of twelve”.- Peer inspection of practices by national societies.

Download the document (PDF format - 50,8 Kb) (PDF)

  • Development of evidence based clinical guidelines by national societies based on the AGREE criteria (
  • European quality indicator project (EQUIP) 

Quality is the core business of internal medicine as defined by safety, effectiveness, efficiency and patient-centred medical care. To assess the quality of care, indicators should be developed by a rigorous, standardized method and measured in internal medicine practice in Europe.   
Therefore the working group on Quality of Care used an ICT type RAND modified Delphy to extract indicators from evidence based guidelines. 
The following conditions should be met:
Data collection should be webbased, easy to extract, gather and understood and user friendly. The indicators should be based on recommendations from clinical evidence-based guidelines. Preferably ICT approachable databases should be the source of information with patient records or patient surveys as second best. The setting of the study is the outpatient clinic or the emergency unit. 
First 7 internal diseases were selected, and 20 indicators defined. Following a survey amongst EFIM members and further analysis and discussions in the group, the indicators were reduced to 6 for 3 diseases: 2 for diabetes mellitus, 2 for cardiovascular risk management, and 2 for hypertension. 
For each of the indicators, the following scheme was filled in:

  • Description and relevance with evidence level
  • Definition of nominator and denominator with data source
  • In- and exclusion criteria
  • Adjustments (sociodemographic or for case mix)
  • Mean or median score and variance
  • Minimum and Optimal level
  • Literature

Before analysing these indicators in at least 5 European countries a check on measurability has to be performed, because it is known that during such a check half of the indicators are either not registred, have an alternative administration definition or important other clinical criteria cannot be found. For this data check on traceability and validity the intention is to analyse 30 samples per indicator from 3 types of practices in the Netherlands (one University Hospital practice, one large and one small teaching hospital): a feasibility study. As it is known that the measurement, registration and tabulation of one indicator usually take a bit less than 30 minutes the sampling of 180 indicators will take 100 hours. If an epidemiologist performs the job at a salary of 100 euros per hour, the feasibility study will cost 10.000 euros. 
If your society would like to offer a financial contribution to the project, please contact Harry van Hulsteijn at, for more information.

For further information about the Quality of Care Working & Professional Issues Working Group please contact the Chairman:

Mark H.H. Kramer, MD PhD FRCP FACP Professor of Medicine | Chair department of Internal Medicine
VU University Medical Center
Visiting address: De Boelelaan 1117 (Room 4 A 34)
phone: +31(0)20-4444309 | fax: +31(0)20-4444313