Supporting quality care in general practice: The collaboratives approach

2008 ◽  
Vol 14 (2) ◽  
pp. 46 ◽  
Author(s):  
Catuscia Buiso ◽  
Bill Newton
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Chronic Disease ◽  
Quality Care ◽  
Quality Improvement Initiative ◽  
Building Practice ◽  
The Impact ◽  
International Phenomenon

An important role of divisions of general practice is to support general practice to build capacity for the delivery of quality care. The purpose of this paper is to discuss the National Primary Care Collaboratives Program and the impact this quality improvement initiative has had on building practice capacity to achieve improvements in the management of chronic disease. "The Collaboratives" are an international phenomenon, which, over the last three years, has been implemented in Australia and has achieved impressive results consistent with the success documented in other countries. This paper explores the key elements contributing to the success of the program and discusses the opportunities that have strengthened the ability of participating divisions to support general practice to deliver quality care.

scholarly journals An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

2021 ◽  
Vol 10 (2) ◽  
pp. e000839
Author(s):  
Heather Cassie ◽  
Vinay Mistry ◽  
Laura Beaton ◽  
Irene Black ◽  
Janet E Clarkson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Case Studies ◽  
Quality Care ◽  
Theoretical Domains Framework ◽  
Team Members ◽  
Knowledge And Skills ◽  
Scottish Government ◽  
The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

scholarly journals Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London

2020 ◽  
Vol 71 (702) ◽  
pp. e31-e38
Author(s):  
Tom Margham ◽  
Crystal Williams ◽  
Jack Steadman ◽  
Sally Hull
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Effective Practice ◽  
Missed Appointments ◽  
Post Intervention ◽  
Primary Care Sector ◽  
Appointment System ◽  
Times Series Analysis ◽  
The Impact

BackgroundMissed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector.AimTo evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions.Design and settingPractices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population.MethodStudy practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis.ResultsIn total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%.ConclusionForward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.

scholarly journals 1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Jegatheeswaran ◽  
B Choi ◽  
M F Rocha ◽  
A Green
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Face To Face ◽  
Retrospective Audit ◽  
Nice Guidance ◽  
Ear Wax ◽  
The Face ◽  
The Impact

Abstract Aim The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals. Method An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020. Results In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November. Conclusions Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.

The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China

2020 ◽  
Author(s):  
Zhongqing Xu ◽  
Jingchun Fan ◽  
Jingjing Ding ◽  
Xianzhen Feng ◽  
Shunyu Tao ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Teaching Hospital ◽  
The Impact

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

Improving the Timely Delivery of Antihypertensive Medication for Severe Perinatal Hypertension in Pregnancy and Postpartum

2021 ◽  
Author(s):  
Patrick Schneider ◽  
Patricia Ann Lee King ◽  
Lauren Keenan-Devlin ◽  
Ann E.B. Borders
Keyword(s):  
Quality Improvement ◽  
Postpartum Period ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Elevated Blood ◽  
Statistical Process ◽  
Pregnancy And Postpartum ◽  
Blood Pressures ◽  
The Impact ◽  
Timely Delivery

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period. Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time. Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01). Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process. Key Points

scholarly journals From Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementation Context

2021 ◽  
pp. 104973232110586
Author(s):  
Abimbola A. Olaniran ◽  
Modupe Oludipe ◽  
Zelee Hill ◽  
Adedoyin Ogunyemi ◽  
Nasir Umar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Local Governance ◽  
Governance Structure ◽  
Public Hospitals ◽  
Theory Of Change ◽  
Change Implementation ◽  
Quality Improvement Initiative ◽  
Primary Health Centres ◽  
Implementation Context

As countries continue to invest in quality improvement (QI) initiatives in health facilities, it is important to acknowledge the role of context in implementation. We conducted a qualitative study between February 2019 and January 2020 to explore how a QI initiative was adapted to enable implementation in three facility types: primary health centres, public hospitals and private facilities in Lagos State, Nigeria. Despite a common theory of change, implementation of the initiative needed to be adapted to accommodate the local needs, priorities and organisational culture of each facility type. Across facility types, inadequate human and capital resources constrained implementation and necessitated an extension of the initiative’s duration. In public facilities, the local governance structure was adapted to facilitate coordination, but similar adaptations to governance were not possible for private facilities. Our findings highlight the importance of anticipating and planning for the local adaptation of QI initiatives according to implementation environment.

Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

2011 ◽  
Vol 32 (7) ◽  
pp. 635-640 ◽  
Author(s):  
Marc-Oliver Wright ◽  
Maureen Kharasch ◽  
Jennifer L. Beaumont ◽  
Lance R. Peterson ◽  
Ari Robicsek
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Quality Improvement Initiative ◽  
Infection Rates ◽  
Improvement Program ◽  
Nursing Unit ◽  
Accepted Practice ◽  
Device Associated Infection ◽  
Tract Infections ◽  
The Impact

Objective.To evaluate two different methods of measuring catheter-associated urinary tract infection (CAUTI) rates in the setting of a quality improvement initiative aimed at reducing device utilization.Design, Setting, and Patients.Comparison of CAUTI measurements in the context of a before-after trial of acute care adult admissions to a multicentered healthcare system.Methods.CAUTIs were identified with an automated surveillance system, and device-days were measured through an electronic health record. Traditional surveillance measures of CAUTI rates per 1,000 device-days (R1) were compared with CAUTI rates per 10,000 patient-days (R2) before (T1) and after (T2) an intervention aimed at reducing catheter utilization.Results.The device-utilization ratio declined from 0.36 to 0.28 between T1 and T2 (P< .001), while infection rates were significantly lower when measured by R2 (28.2 vs 23.2, P = .02). When measured by R1, however, infection rates trended upward by 6% (7.79 vs. 8.28, P = .47), and at the nursing unit level, reduction in device utilization was significantly associated with increases in infection rate.Conclusions.The widely accepted practice of using device-days as a method of risk adjustment to calculate device-associated infection rates may mask the impact of a successful quality improvement program and reward programs not actively engaged in reducing device usage.

scholarly journals Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

2009 ◽  
Vol 7 (4) ◽  
pp. 309-318 ◽  
Author(s):  
G. M. Russell ◽  
S. Dahrouge ◽  
W. Hogg ◽  
R. Geneau ◽  
L. Muldoon ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Organizational Factors ◽  
The Impact

EP.TU.991Developing as Future Leaders: A Systematic Review of Quality Improvement Training in Junior Doctors

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rabiya Aseem ◽  
Costas Simillis ◽  
Jason Smith ◽  
Sonal Arora ◽  
Nikhil Pawa
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
English Language ◽  
Quality Care ◽  
Leadership Skills ◽  
Training Programme ◽  
Junior Doctors ◽  
Training Methods ◽  
Effectiveness Of Training ◽  
The Impact

Abstract Aims Quality improvement (QI) training in Junior Doctors (JDs) is essential for providing High Quality Care for patients and facilitating organisational success. The aim of this study was to systematically review the evidence on QI training in JDs and determine the impact and effectiveness of training methods. Methods A systematic review was conducted as per PRISMA guidelines. Searches were carried out using MEDLINE, EMBASE and HMIC for English-Language articles between January 2005 to December 2019. Selected articles underwent critical appraisal using the CASP criteria by two independent reviewers. A qualitative and thematic analysis was conducted. Results 43 studies were identified in a range of medical and surgical specialities. Common QI methodology included theoretical and project-based curricula with content focussing on PDSA cycles, root causes analyses and project development. Majority of studies reported improved knowledge, leadership skills and satisfaction. Mentorship and coaching were highly valued, but few studies adhered to this practice. Few studies demonstrated increased QI engagement. Key themes identified (i) Effectiveness of QI training (ii) Barriers to engagement (iii) Organizational culture of fostering QI. Conclusion There is growing mandate for training JDs in QI practices to enhance patient care. QI curricula targeting JDs have demonstrated improved knowledge and leadership skills. Nonetheless, significant barriers in QI engagement endure. Additional research is required to combat disengagement and assess sustainability of QI interventions in JDs. We further aim to introduce a pilot QI training programme for surgical JDs to enhance leadership skills.

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