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.

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.

Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

2021 ◽  
pp. 107839032199416
Author(s):  
Sarah Stalder ◽  
Aimee Techau ◽  
Jenny Hamilton ◽  
Carlo Caballero ◽  
Mary Weber ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Team ◽  
Psychiatric Nurse ◽  
Care Providers ◽  
Team Members ◽  
Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

2021 ◽  
pp. 193229682199872
Author(s):  
Gregg D. Simonson ◽  
Richard M. Bergenstal ◽  
Mary L. Johnson ◽  
Janet L. Davidson ◽  
Thomas W. Martens
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glucose Monitoring ◽  
Care Model ◽  
Time In Range ◽  
Glucose Management ◽  
The Impact ◽  
Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

scholarly journals Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001425
Author(s):  
Marc Meller Søndergaard ◽  
Johannes Riis ◽  
Karoline Willum Bodker ◽  
Steen Møller Hansen ◽  
Jesper Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Heart Rate ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

scholarly journals Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard A. Parker ◽  
Paul Padfield ◽  
Janet Hanley ◽  
Hilary Pinnock ◽  
John Kennedy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Statistical Analysis ◽  
Propensity Score ◽  
Random Coefficient ◽  
White Coat ◽  
White Coat Effect ◽  
Regression Adjustment ◽  
The Impact

Abstract Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

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.

Quality Improvement: An ACQIP Exercise on the Management of Otitis Media

1996 ◽  
Vol 17 (7) ◽  
pp. 251-256
Author(s):  
Robert H. Sebring ◽  
Keyword(s):  
Quality Improvement ◽  
American Academy ◽  
Otitis Media ◽  
Quality Care ◽  
Care Quality ◽  
Self Assessment ◽  
Improvement Program ◽  
Additional Information ◽  
American Academy Of Pediatrics

As part of Pediatrics in Review's ongoing focus on quality improvement, we present a self-assessment exercise taken from the American Academy of Pediatrics' Ambulatory Care Quality Improvement Program (ACQIP). Tabulated responses of pediatricians who completed this exercise as part of the ACQIP program are presented on pages 253 to 254, allowing readers to see how their own answers compare and providing material for thought and discussion. Readers are encouraged to participate in the ACQIP program. Additional information can be obtained by calling or writing the Division of Quality Care, American Academy of Pediatrics, Box 927, Elk Grove Village, IL 60009-0927. Monitoring Otitis Media EDUCATIONAL OBJECTIVES This exercise and the follow-up materials should help you identify areas of improvement in how your practice monitors and documents information for children with acute or chronic otitis. INSTRUCTIONS Beginning with tomorrow's appointments, answer the questions below for the most recent, but not the current episode of otitis media in the first 10 patients you see who are younger than 4 years of age and experiencing at least their second episode of otitis. You will need to review charts to answer the questions. Put a check in each box in which you find the information in your medical record listed.

Primary care and all-cause mortality in urban China: a mixed-level analysis

2020 ◽  
Author(s):  
Quan Zhang
Keyword(s):  
Primary Care ◽  
Mortality Risk ◽  
Health Care Access ◽  
Community Dwelling ◽  
Urban China ◽  
Community Level ◽  
Promoting Effect ◽  
Primary Care Supply ◽  
The Impact

Abstract Background There is still a lack of evidence focusing on primary care supply in developing countries where the educational achievement of primary care practitioners is relatively low. Objectives By using a nationally representative longitudinal and prospective cohort study, this study examined whether primary care supply, measured by the availability and the number of community health centres (CHCs), was associated with 4-year mortality risk among community-dwelling participants aged 45 and above in urban China. Methods Using the 2011 and 2015 waves of the China Health and Retirement Longitudinal Survey (CHARLS), we conducted a longitudinal mixed-level logistic analysis to study the impact of the availability and the number of CHC on 4-year follow-up mortality risk, after adjusting community- and individual-level covariates. Results Individuals living in communities with CHC were 31% less likely to die during the 4-year follow-up (P &lt; 0.05) conditional on community-level characteristics, including the basic facilities availability, population size and physical area, and individuals’ socio-demographic and health characteristics and health behaviours. Also, an increased number of community-level CHC was shown to decrease residents’ 4-year mortality risk significantly (odds ratio = 0.82, P &lt; 0.05). Furthermore, the association was more pronounced among adults aged 65 and above. Conclusion This study provides additional evidence of the health-promoting effect of primary care supply among urban residents in China. Improving primary care coverage in China should be necessary to improve health care access, thus promoting population health.

The biopsychosocial (BPS) model of dementia as a tool for clinical practice. A pilot study

2016 ◽  
Vol 28 (7) ◽  
pp. 1079-1089 ◽  
Author(s):  
Catherine Revolta ◽  
Martin Orrell ◽  
Aimee Spector
Keyword(s):  
Quality Care ◽  
Preliminary Evidence ◽  
Sense Of Competence ◽  
Positive Attitudes ◽  
People With Dementia ◽  
Within Subjects ◽  
Treatment Plans ◽  
Practical Tool ◽  
The Impact

ABSTRACTBackground:Equipping staff with the skills to provide high quality care in dementia is essential. The Biopsychosocial (BPS) model of dementia (Spector and Orrell, 2010) is a practical tool designed to encourage staff to develop personalized interventions and treatment plans for people with dementia. This feasibility study aimed to examine the impact of training staff to use the BPS model on skills of formulation, attitude towards dementia and sense of role competence.Method:A within-subjects design was used. Thirty-seven staff working in dementia care across a community mental health team (CMHT), inpatient wards, and residential care homes were trained to use the BPS model. Outcomes were measured at baseline, post-training, and four week follow-up.Results:The ability of staff to understand, formulate, and develop interventions for people with dementia increased significantly following training. There were small, non-significant improvements in positive attitudes, and sense of competence following training. Staff also reported that training improved their understanding of biological and psychosocial factors in dementia.Conclusions:This study provides preliminary evidence that training staff to use the BPS model can lead to improvements in their ability to understand and develop interventions for people with dementia. Further research would be required to draw firm conclusions about its effectiveness.

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