Long-Term Benefits of Short-Term Quality Improvement Interventions for Depressed Youths in Primary Care

2009 ◽  
Vol 166 (9) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joan Rosenbaum Asarnow ◽  
Lisa H. Jaycox ◽  
Lingqi Tang ◽  
Naihua Duan ◽  
Anne P. LaBorde ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Short Term ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

scholarly journals Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Jennifer M. Weiss ◽  
Perry J. Pickhardt ◽  
Jessica R. Schumacher ◽  
Aaron Potvien ◽  
David H. Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Quality Improvement ◽  
Primary Care Providers ◽  
Care Providers ◽  
Provider Perceptions ◽  
Crc Screening ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
Screening Barriers

Aims. Colorectal cancer (CRC) screening is underutilized. Increasing CRC screening rates requires interventions targeting multiple barriers at each level of the healthcare organization (patient, provider, and system). We examined groups of primary care providers (PCPs) based on perceptions of screening barriers and the relationship to CRC screening rates to inform approaches for conducting barrier assessments prior to designing and implementing quality improvement interventions.Methods. We conducted a retrospective cohort study linking EHR and survey data. PCPs with complete survey responses for questions addressing CRC screening barriers were included (N=166PCPs; 39,430 patients eligible for CRC screening). Cluster analysis identified groups of PCPs. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for predictors of membership in one of the PCP groups.Results. We found two distinct groups: (1) PCPs identifying multiple barriers to CRC screening at patient, provider, and system levels (N=75) and (2) PCPs identifying no major barriers to screening (N=91). PCPs in the top half of CRC screening performance were more likely to identify multiple barriers than the bottom performers (OR, 4.14; 95% CI, 2.43–7.08).Conclusions. High-performing PCPs can more effectively identify CRC screening barriers. Targeting high-performers when conducting a barrier assessment is a novel approach to assist in designing quality improvement interventions for CRC screening.

scholarly journals Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Celia Laur ◽  
Ann Marie Corrado ◽  
Jeremy M. Grimshaw ◽  
Noah Ivers
Keyword(s):  
Quality Improvement ◽  
Snowball Sampling ◽  
Case Examples ◽  
Telephone Interviews ◽  
Effective Interventions ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

Abstract Background Quality improvement (QI) evaluations rarely consider how a successful intervention can be sustained long term, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained. This study explores why and how the effective interventions were sustained, spread, or scaled. Methods A qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for telephone interviews. Authors were eligible if they had completed the author survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed “effective.” Snowball sampling was used if the participant identified someone who could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify barriers and facilitators to sustainability, spread, and/or scale of the QI program, using case examples to show trajectories across projects and people. Results Eleven of 44 eligible trialists participated in an interview. Four reported that the intervention was “sustained” and nine were “spread,” however, interviews highlighted that these terms were interpreted differently over time and between participants. Participant stories highlighted the varied trajectories of how projects evolved and how some research careers adapted to increase impact. Three interacting themes, termed the “3C’s,” helped explain the variation in sustainability, spread, and scale: (i) understanding the concepts of implementation, sustainability, sustainment, spread, and scale; (ii) having the appropriate competencies; and (iii) the need for individual, organizational, and system capacity. Conclusions Challenges in defining sustainability, spread and scale make it difficult to fully understand impact. However, it is clear that from the beginning of intervention design, trialists need to understand the concepts and have the competency and capacity to plan for feasible and sustainable interventions that have potential to be sustained, spread and/or scaled if found to be effective.

Practice-level quality improvement interventions in primary care: a review of systematic reviews

2015 ◽  
Vol 16 (06) ◽  
pp. 556-577 ◽  
Author(s):  
Ryan Irwin ◽  
Tim Stokes ◽  
Tom Marshall
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Systematic Reviews ◽  
Audit And Feedback ◽  
System Level ◽  
Basic Unit ◽  
Practice Level ◽  
Improvement Effect ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

AimTo present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews.BackgroundQuality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care – the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting.MethodsDesign:A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions.Scope:Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions.Outcome measures:A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions.FindingsAudit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions.ConclusionEvidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.

scholarly journals Spatio-temporal associations of air pollutant concentrations, GP respiratory consultations and respiratory inhaler prescriptions: a 5-year study of primary care in the borough of Lambeth, South London

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mark Ashworth ◽  
◽  
Antonis Analitis ◽  
David Whitney ◽  
Evangelia Samoli ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Air Pollutant ◽  
Respiratory Morbidity ◽  
Short Term ◽  
Short Term Exposure ◽  
Short And Long Term ◽  
Spatio Temporal

Abstract Background Although the associations of outdoor air pollution exposure with mortality and hospital admissions are well established, few previous studies have reported on primary care clinical and prescribing data. We assessed the associations of short and long-term pollutant exposures with General Practitioner respiratory consultations and inhaler prescriptions. Methods Daily primary care data, for 2009–2013, were obtained from Lambeth DataNet (LDN), an anonymised dataset containing coded data from all patients (1.2 million) registered at general practices in Lambeth, an inner-city south London borough. Counts of respiratory consultations and inhaler prescriptions by day and Lower Super Output Area (LSOA) of residence were constructed. We developed models for predicting daily PM2.5, PM10, NO2 and O3 per LSOA. We used spatio-temporal mixed effects zero inflated negative binomial models to investigate the simultaneous short- and long-term effects of exposure to pollutants on the number of events. Results The mean concentrations of NO2, PM10, PM2.5 and O3 over the study period were 50.7, 21.2, 15.6, and 49.9 μg/m3 respectively, with all pollutants except NO2 having much larger temporal rather than spatial variability. Following short-term exposure increases to PM10, NO2 and PM2.5 the number of consultations and inhaler prescriptions were found to increase, especially for PM10 exposure in children which was associated with increases in daily respiratory consultations of 3.4% and inhaler prescriptions of 0.8%, per PM10 interquartile range (IQR) increase. Associations further increased after adjustment for weekly average exposures, rising to 6.1 and 1.2%, respectively, for weekly average PM10 exposure. In contrast, a short-term increase in O3 exposure was associated with decreased number of respiratory consultations. No association was found between long-term exposures to PM10, PM2.5 and NO2 and number of respiratory consultations. Long-term exposure to NO2 was associated with an increase (8%) in preventer inhaler prescriptions only. Conclusions We found increases in the daily number of GP respiratory consultations and inhaler prescriptions following short-term increases in exposure to NO2, PM10 and PM2.5. These associations are more pronounced in children and persist for at least a week. The association with long term exposure to NO2 and preventer inhaler prescriptions indicates likely increased chronic respiratory morbidity.

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