Diabetes Inside—Following the Long-Term Impact of a Diabetes Quality Improvement (QI) Initiative in Primary Care

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 7-OR
Author(s):  
UMA GUNASEKARAN ◽  
ROY E. FURMAN ◽  
KELLIE M. RODRIGUEZ ◽  
E. ELIZABETH OBIALO ◽  
SENTAYEHU KASSA ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Long Term Impact

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 Development and evaluation of a national gentamicin and vancomycin quality improvement programme

2020 ◽  
Vol 75 (7) ◽  
pp. 1998-2003 ◽  
Author(s):  
Yvonne Semple ◽  
Marion Bennie ◽  
Jacqueline Sneddon ◽  
Alison Cockburn ◽  
R Andrew Seaton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Guideline Implementation ◽  
Mobile App ◽  
Multidisciplinary Teams ◽  
Point Prevalence Study ◽  
National Guidance ◽  
Improvement Programme ◽  
Long Term Impact

Abstract Background Scottish Antimicrobial Prescribing Group (SAPG) recommendations to reduce broad-spectrum antimicrobial use led to an increase in gentamicin and vancomycin prescribing. In 2009, SAPG introduced national guidance to standardize dosage regimens, reduce calculation errors and improve the monitoring of these antibiotics. Studies conducted in 2010 and 2011 identified limitations in guideline implementation. Objectives To develop, implement and assess the long-term impact of quality improvement (QI) resources to support gentamicin and vancomycin prescribing, administration and monitoring. Methods New resources, comprising revised guidelines, online and mobile app dose calculators, educational material and specialized prescribing and monitoring charts were developed in collaboration with antimicrobial specialists and implemented throughout Scotland during 2013–16. An online survey in 2017 evaluated the use of these resources and a before (2011) and after (2018) point prevalence study assessed their impact. Results All 12 boards who responded to the survey (80%) were using the guidance, electronic calculators and gentamicin prescription chart; 8 used a vancomycin chart. The percentage of patients who received the recommended gentamicin dose increased from 44% to 89% (OR 10.99, 95% CI = 6.37–18.95) between 2011 and 2018. For vancomycin, the correct loading dose increased from 50% to 85% (OR = 5.69, CI = 2.76–11.71) and the correct maintenance dose from 55% to 90% (OR = 7.17, CI = 3.01–17.07). Conclusions This study demonstrated improvements in the national prescribing of gentamicin and vancomycin through the development and coordinated implementation of a range of QI resources and engagement with local and national multidisciplinary teams.

Short- and Long-term Impact of an Inpatient Quality Improvement Initiative

2013 ◽  
Vol 33 (4) ◽  
pp. 212-219 ◽  
Author(s):  
Randal J. Thomas ◽  
Kashish Goel ◽  
Marwan Jumean ◽  
Charles Mullany ◽  
Brian Lahr ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Short And Long Term ◽  
Long Term Impact

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 Value of Primary Care Diabetes Bundle Management: Long-Term Impact on Cost

2015 ◽  
Vol 2 (2) ◽  
pp. 91-92 ◽  
Author(s):  
Daniel D. Maeng ◽  
Yan Xiaowei ◽  
Thomas R Graf
Keyword(s):  
Primary Care ◽  
Long Term Impact

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

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