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.


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