scholarly journals Long-term Effectiveness of Disseminating Quality Improvement for Depression in Primary Care

2001 ◽  
Vol 58 (7) ◽  
pp. 696 ◽  
Author(s):  
Cathy D. Sherbourne ◽  
Kenneth B. Wells ◽  
Naihua Duan ◽  
Jeanne Miranda ◽  
Jürgen Unützer ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement

scholarly journals Ten tips for advancing a culture of improvement in primary care

2018 ◽  
Vol 28 (7) ◽  
pp. 582-587 ◽  
Author(s):  
Tara Kiran ◽  
Noor Ramji ◽  
Mary Beth Derocher ◽  
Rajesh Girdhari ◽  
Samantha Davie ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Patient Care ◽  
Performance Measures ◽  
Primary Care Practice ◽  
Care Practice ◽  
Professional Satisfaction ◽  
Large Primary ◽  
Healthcare Leaders

Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.

scholarly journals Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians

2000 ◽  
Vol 15 (12) ◽  
pp. 868-877 ◽  
Author(s):  
Lisa S. Meredith ◽  
Maga Jackson-Triche ◽  
Naihua Duan ◽  
Lisa V. Rubenstein ◽  
Patti Camp ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Treatment Knowledge ◽  
Primary Care Clinicians

scholarly journals Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project.

2020 ◽  
Author(s):  
Aleksandra E Zgierska ◽  
James M Robinson ◽  
Robert P Lennon ◽  
Paul D Smith ◽  
Kate Nisbet ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Cancer Pain ◽  
System Level ◽  
Stepped Wedge ◽  
Convenience Sample ◽  
Clinic Staff ◽  
Opioid Prescribing ◽  
Urine Drug

Abstract Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p<0.05, 95% confidence intervals and/or Cohen’s d. Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1,255 patients in the QI and 1,632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p=0.019) and prescribed ≥90mg/day MED (23.0% vs 15.5%, p=0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p=0.02), but not other outcomes (p³0.05). Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented.Trial Registration – Not applicable

scholarly journals Effects of Practice Turnover on Primary Care Quality Improvement Implementation

2019 ◽  
Vol 35 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Andrea N. Baron ◽  
Jennifer R. Hemler ◽  
Shannon M. Sweeney ◽  
Tanisha Tate Woodson ◽  
Allison Cuthel ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Large Scale ◽  
Team Building ◽  
Care Quality ◽  
Working Relationships ◽  
Primary Care Quality ◽  
Primary Care Practices ◽  
The Relationship

Primary care practices often engage in quality improvement (QI) in order to stay current and meet quality benchmarks, but the extent to which turnover affects practices’ QI ability is not well described. The authors examined qualitative data from practice staff and external facilitators participating in a large-scale QI initiative to understand the relationship between turnover and QI efforts. The examination found turnover can limit practices’ ability to engage in QI activities in various ways. When a staff member leaves, remaining staff often absorb additional responsibilities, and QI momentum slows as new staff are trained or existing staff are reengaged. Turnover alters staff dynamics and can create barriers to constructive working relationships and team building. When key practice members leave, they can take with them institutional memory about QI purpose, processes, and long-term vision. Understanding how turnover affects QI may help practices, and those helping them with QI, manage the disruptive effects of turnover.

scholarly journals Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project.

2020 ◽  
Author(s):  
Aleksandra E Zgierska ◽  
James M Robinson ◽  
Robert P Lennon ◽  
Paul D Smith ◽  
Kate Nisbet ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Cancer Pain ◽  
System Level ◽  
Stepped Wedge ◽  
Convenience Sample ◽  
Clinic Staff ◽  
Opioid Prescribing ◽  
Urine Drug

Abstract Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations.Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p<0.05, 95% confidence intervals and/or Cohen’s d.Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1,255 patients in the QI and 1,632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p=0.019) and prescribed ≥90mg/day MED (23.0% vs 15.5%, p=0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p=0.02), but not other outcomes (p³0.05).Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented.Trial Registration – Not applicable

scholarly journals Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project.

2020 ◽  
Author(s):  
Aleksandra E Zgierska ◽  
James M Robinson ◽  
Robert P Lennon ◽  
Paul D Smith ◽  
Kate Nisbet ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Cancer Pain ◽  
System Level ◽  
Stepped Wedge ◽  
Convenience Sample ◽  
Clinic Staff ◽  
Opioid Prescribing ◽  
Urine Drug

Abstract Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p<0.05, 95% confidence intervals and/or Cohen’s d. Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1,255 patients in the QI and 1,632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p=0.019) and prescribed ≥90mg/day MED (23.0% vs 15.5%, p=0.038). The stepped-wedge analysis did not show statistically significant change in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p=0.02), but not other outcomes (p³0.05). Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented.Trial Registration – Not applicable

scholarly journals Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Aleksandra E. Zgierska ◽  
James M. Robinson ◽  
Robert P. Lennon ◽  
Paul D. Smith ◽  
Kate Nisbet ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Cancer Pain ◽  
System Level ◽  
Stepped Wedge ◽  
Convenience Sample ◽  
Clinic Staff ◽  
Opioid Prescribing ◽  
Urine Drug

Abstract Background Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4–6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse risk screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90 mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p < 0.05, 95% confidence intervals and/or Cohen’s d. Results Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1255 patients in the QI and 1632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p = 0.019) and prescribed ≥90 mg/day MED (23.0% vs 15.5%, p = 0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90 mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p = 0.02), but not other outcomes (p ≥ 0.05). Conclusions Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented. Trial registration Not applicable.

Long-Term Benefits of Short-Term Quality Improvement Interventions for Depressed Youths in Primary Care

2009 ◽  
Vol 166 (9) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joan Rosenbaum Asarnow ◽  
Lisa H. Jaycox ◽  
Lingqi Tang ◽  
Naihua Duan ◽  
Anne P. LaBorde ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Short Term ◽  
Improvement Interventions ◽  
Quality Improvement Interventions
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