Impact of a quality improvement program on primary healthcare in Canada: a mixed-method evaluation

Stewart B Harris; Michael E Green; Judith Belle Brown; Sharon Roberts; Grant Russell; Meghan Fournie; Susan Webster-Bogaert; Jann Paquette-Warren; Jyoti Kotecha; Han Han; Amardeep Thind; Moira Stewart; Sonja Reichert; Jordan W Tompkins; Richard Birtwhistle

doi:10.1016/j.healthpol.2014.10.019

Impact of a quality improvement program on primary healthcare in Canada: a mixed-method evaluation

Health Policy. 2015 Apr;119(4):405-16. doi: 10.1016/j.healthpol.2014.10.019. Epub 2014 Nov 5.

Authors

Affiliations

¹ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: stewart.harris@schulich.uwo.ca.
² Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: michael.green@dfm.queensu.ca.
³ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: judith.brown@schulich.uwo.ca.
⁴ Renison University College at the University of Waterloo, 240 Westmount Road North, Waterloo, Ontario Canada N2L 3G4. Electronic address: serobert@uwaterloo.ca.
⁵ Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill VIC, 3168, Australia. Electronic address: grant.russell@med.monash.edu.au.
⁶ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: meghan.fournie@schulich.uwo.ca.
⁷ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: susan.webster-bogaert@schulich.uwo.ca.
⁸ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: jann.paquette-warren@schulich.uwo.ca.
⁹ Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: jyoti.kotecha@cspc.queensu.ca.
¹⁰ Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: han.han@cspc.queensu.ca.
¹¹ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, Room K201, London, Ontario, Canada. Electronic address: amardeep.thind@schulich.uwo.ca.
¹² Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: moira.stewart@schulich.uwo.ca.
¹³ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: sonja.reichert@schulich.uwo.ca.
¹⁴ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: jordan.tompkins@schulich.uwo.ca.
¹⁵ Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: richard.birtwhistle@dfm.queensu.ca.

PMID: 25476553
DOI: 10.1016/j.healthpol.2014.10.019

Abstract

Purpose: Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement and Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning.

Methods: This article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: (1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; (2) post-only advanced access survey (third-next available appointment); and (3) post-only semi-structured interviews (team functioning).

Results: Chart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p=0.10]; foot exams [p=0.45]; CRC screening [p=0.77]; advanced access [p=0.22]). Qualitative interview (n=42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity.

Conclusion: The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.

Keywords: Advanced access; Colorectal cancer screening; Diabetes; Evaluation; Interdisciplinary teams; Primary healthcare; Quality improvement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Colorectal Neoplasms / diagnosis
Cooperative Behavior
Diabetes Mellitus, Type 2 / therapy
Female
Humans
Male
Medical Audit
Middle Aged
Ontario
Primary Health Care / standards*
Program Evaluation
Quality Improvement / organization & administration*
Quality Indicators, Health Care
Retrospective Studies