scholarly journals Conditions and Barriers for Quality Improvement Work. A Qualitative Study of How Professionals and Health Centre Managers Experience Audit and Feedback Practices in Swedish Primary Care

2021 ◽  
Author(s):  
Eva Arvidsson ◽  
Sofia Dahlin ◽  
Anders Anell
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Clinical Performance ◽  
Health Centre ◽  
Audit And Feedback ◽  
Macro Level ◽  
Care Experience ◽  
Professional Perspective ◽  
Health Centres ◽  
Clinical Measures

Abstract BackgroundHigh quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement. MethodsWe used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis.ResultsFour different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres.ConclusionsProfessionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which would favour transformation to a primary care based system.

scholarly journals Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eva Arvidsson ◽  
Sofia Dahlin ◽  
Anders Anell
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Qualitative Content Analysis ◽  
Health Centre ◽  
Audit And Feedback ◽  
Macro Level ◽  
Care Experience ◽  
Professional Perspective ◽  
Health Centres ◽  
Clinical Measures

Abstract Background High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement. Methods We used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis. Results Four different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres. Conclusions Professionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.

Primary care providers’ responses to pregnancy intention screening challenges: community-based participatory research at an urban community health centre

2019 ◽  
Vol 36 (6) ◽  
pp. 797-803 ◽  
Author(s):  
Silpa Srinivasulu ◽  
Katherine A Falletta ◽  
Dayana Bermudez ◽  
Yolyn Almonte ◽  
Rachel Baum ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Centre ◽  
Community Based Participatory Research ◽  
Primary Care Providers ◽  
Pregnancy Intention ◽  
Reproductive Age ◽  
Care Providers ◽  
Women Of Reproductive Age ◽  
Community Based ◽  
Health Centres

Abstract Background Incorporating pregnancy intention screening into primary care to address unmet preconception and contraception needs may improve delivery of family planning services. A notable research gap exists regarding providers’ experiences conducting this screening in primary care. Objective To explore primary care providers’ perceived challenges in conducting pregnancy intention screening with women of reproductive age and to identify strategies to discuss this in primary care settings. Methods This qualitative study emerged from a 2017 community-based participatory research project. We conducted semi-structured, in-depth interviews with 10 primary care providers who care for women of reproductive age at an urban federally qualified health centre. Analysis consisted of interview debriefing, transcript coding and content analysis with the Community Advisory Board. Results Across departments, respondents acknowledged difficulties conducting pregnancy intention screening and identified strategies for working with patients’ individual readiness to discuss pregnancy intention. Strategies included: linking patients’ health concerns with sexual and reproductive health, applying a shared decision-making model to all patient–provider interactions, practicing goal setting and motivational interviewing, fostering non-judgmental relationships and introducing pregnancy intention in one visit but following up at later times when more relevant for patients. Conclusions Opportunities exist for health centres to address pregnancy intention screening challenges, such as implementing routine screening and waiting room tools to foster provider and patient agency and sharing best practices with providers across departments by facilitating comprehensive training and periodic check-ins. Exploring providers’ experiences may assist health centres in improving pregnancy intention screening in the primary care setting.

Primary care utilization and clinical quality performance: a comparison between health centres in Medicaid expansion states and non-expansion states

2018 ◽  
Vol 24 (1) ◽  
pp. 19-28 ◽  
Author(s):  
De-Chih Lee ◽  
Leiyu Shi ◽  
Hailun Liang
Keyword(s):  
Primary Care ◽  
Health Centre ◽  
Quality Measures ◽  
Care Utilization ◽  
Medicaid Expansion ◽  
Quality Performance ◽  
Clinical Quality ◽  
Medical Visits ◽  
Health Centres ◽  
Primary Care Utilization

Objectives The United States Government’s Medicaid expansion policy has important implications for health centres, since a large proportion of health centre patients are Medicaid enrollees. The objective of this study was to compare primary care utilization and clinical quality performance between health centres in Medicaid expansion states and those in Medicaid non-expansion states. Methods We conducted a cross-sectional study. Multiple regressions, using a standard linear model, were performed to examine the relationship between Medicaid expansion status and performance measures, accounting for covariates. Results Our results showed that in unadjusted analyses, health centres in Medicaid expansion states reported larger number of patients served, larger number of medical visits, a higher percentage of Medicaid patients, and better performance in seven of 16 clinical quality measures than those in Medicaid non-expansion states. After controlling for relevant health centre-level covariates, the differences in mean patients served, mean medical visits, percentage of Medicaid patients, and five clinical quality measures still existed. Conclusions These findings reveal significant associations between Medicaid expansion and primary care utilization and the quality of care. Medicaid expansion has demonstrated its potential role in promoting primary care for vulnerable populations served by health centres.

scholarly journals The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna H. Glenngård ◽  
Anders Anell
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Audit And Feedback ◽  
Primary Care Centre ◽  
Research Approach ◽  
Care Centre ◽  
Bottom Up ◽  
Complex Change ◽  
Facilitators And Barriers ◽  
The Impact

Abstract Background This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how different types of A&F support change behaviour by influencing different forms of motivation and learning, and what contextual facilitators and barriers enable or obstruct change behaviour in primary care. Methods A qualitative research approach was used. We explored views about the impact of A&F across managers of 27 PCCs, in five Swedish regions, through semi-structured interviews. A purposeful sampling was used to identify both regions and PCC managers, in order to explore multiple perspectives. We used the COM-B framework, which describes how Capability, Opportunity and Motivation interact and generate change behaviour and how different factors might act as facilitators or barriers, when collecting and analysing data. Results Existing forms of A&F were perceived as coercive top-down interventions to secure adherence to contractual obligations, financial targets and clinical guidelines. Support to bottom-up approaches and more complex change at team and organisational levels was perceived as limited. We identified five contextual factors that matter for the impact of A&F on change behaviour and quality improvement work: performance of organisations, continuity in staff, size of organisations, flexibility in leadership and management, and flexibility offered by the external environment. Conclusions External A&F, perceived as coercive by recipients of feedback, can have an impact on change behaviour through ‘know-what’ and ‘know-why’ types of knowledge and ‘have-to’ commitment but provide limited support to complex change. ‘Want-to’ commitment and bottom-up driven processes are important for more complex change. Similar to previous research, identified facilitators and barriers of change consisted of factors that are difficult to influence by A&F activities. Future research is needed on how to ensure co-development of A&F models that are perceived as legitimate by health care professionals and useful to support more complex change.

scholarly journals Unpacking the intention to action gap: a qualitative study understanding how physicians engage with audit and feedback

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laura Desveaux ◽  
Noah Michael Ivers ◽  
Kim Devotta ◽  
Noor Ramji ◽  
Karen Weyman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Performance ◽  
Practice Change ◽  
Audit And Feedback ◽  
Improve Quality ◽  
Structured Interviews ◽  
Practice Level ◽  
Individualized Care ◽  
Ability To Act ◽  
Level Data

Abstract Background Audit and feedback (A&F) often successfully enhances health professionals’ intentions to improve quality of care but does not consistently lead to practice changes. Recipients often cite data credibility and limited resources as barriers impeding their ability to act upon A&F, suggesting the intention-to-action gap manifests while recipients are interacting with their data. While attention has been paid to the role feedback and contextual variables play in contributing to (or impeding) success, we lack a nuanced understanding of how healthcare professionals interact with and process clinical performance data. Methods We used qualitative, semi-structured interviews guided by Normalization Process Theory (NPT). Questions explored the role of data in quality improvement, experiences with the A&F report, perceptions of the data, and interpretations and reflections. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a combination of inductive and deductive strategies using reflexive thematic analysis informed by a constructivist paradigm. Results Healthcare professional characteristics (individual quality improvement capabilities and beliefs about data) seem to influence engagement with A&F to a greater degree than feedback variables (i.e., delivered by peers) and observed contextual factors (i.e., strong quality improvement culture). Most participants lacked the capabilities to interpret practice-level data in an actionable way despite a motivation to engage meaningfully. Reasons for the intention-to-action gap included challenges interpreting longitudinal data, appreciating the nuances of common data sources, understanding how aggregate data provides insights into individualized care, and identifying practice-level actions to improve quality. These factors limited effective cognitive participation and collective action, as outlined in NPT. Conclusions A well-designed A&F intervention is necessary but not sufficient to inform practice changes. A&F initiatives must include co-interventions to address recipient characteristics (i.e., beliefs and capabilities) and context to optimize impact. Effective strategies to overcome the intention-to-action gap may include modelling how to use A&F to inform practice change, providing opportunities for social interaction relating to the A&F, and circulating examples of effective actions taken in response to A&F. More broadly, undergraduate medical education and post-graduate training must ensure physicians are equipped with QI capabilities, with an emphasis on the skills required to interpret and act on practice-level data.

scholarly journals The collaboration of general practitioners and nurses in primary care: a comparative analysis of concepts and practices in Slovenia and Spain

2017 ◽  
Vol 18 (05) ◽  
pp. 492-506 ◽  
Author(s):  
Kerstin Hämel ◽  
Carina Vössing
Keyword(s):  
Primary Care ◽  
Nursing Education ◽  
Comparative Analysis ◽  
Qualitative Content Analysis ◽  
Health Centre ◽  
Team Development ◽  
Care Process ◽  
Expert Interviews ◽  
Health Centres ◽  
Effective Collaboration

Aim A comparative analysis of concepts and practices of GP-nurse collaborations in primary health centres in Slovenia and Spain. Background Cross-professional collaboration is considered a key element for providing high-quality comprehensive care by combining the expertise of various professions. In many countries, nurses are also being given new and more extensive responsibilities. Implemented concepts of collaborative care need to be analysed within the context of care concepts, organisational structures, and effective collaboration. Methods Background review of primary care concepts (literature analysis, expert interviews), and evaluation of collaboration in ‘best practice’ health centres in certain regions of Slovenia and Spain. Qualitative content analysis of expert interviews, presentations, observations, and group discussions with professionals and health centre managers. Findings In Slovenian health centres, the collaboration between GPs and nurses has been strongly shaped by their organisation in separate care units and predominantly case-oriented functions. Conventional power structures between professions hinder effective collaboration. The introduction of a new cross-professional primary care concept has integrated advanced practice nurses into general practice. Conventional hierarchies still exist, but a shared vision of preventive care is gradually strengthening attitudes towards team-oriented care. Formal regulations or incentives for teamwork have yet to be implemented. In Spain, health centres were established along with a team-based care concept that encompasses close physician–nurse collaboration and an autonomous role for nurses in the care process. Nurses collaborate with GPs on more equal terms with conflicts centring on professional disagreements. Team development structures and financial incentives for team achievements have been implemented, encouraging teams to generate their own strategies to improve teamwork. Conclusion Clearly defined structures, shared visions of care and team development are important for implementing and maintaining a good collaboration. Central prerequisites are advanced nursing education and greater acceptance of advanced nursing practice.

scholarly journals The correlation between identifying needs and choosing the appropriate productive art for use / primary health care centers as an example

2020 ◽  
Vol 26 (123) ◽  
pp. 131-144
Author(s):  
Zinah Muayad Mahmood ◽  
Mohammed Jasim Mohammed
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Production Efficiency ◽  
Precast Concrete ◽  
Health Centre ◽  
Private Investment ◽  
Concrete Technology ◽  
Health Centres ◽  
Primary Health Care Centers ◽  
The Impact

        The purpose of the study is to identify the need to improve health services in Iraq by determining the efficiency of service in health care centres and working on exploiting limited resources through choosing the most efficient technological art represented by using precast concrete technology to fill the shortfall in the establishment health centres for primary care and to explain the impact of this on saving resources, time, and increasing production efficiency. To achieve this, the quantitative analysis adopted as a methodology in the study by determining the size of the deficit in the infrastructure of health centres for primary care according to the standard of a health centre / 10.000 people with an estimate of the future need for the next ten years depending on the population growth rate estimated by (2.6%). In addition to exploiting the available resources and achieving stability for the population by providing productive employment opportunities within the medium and long term. This makes the study distinguished by originality, as it linked the diagnosis of the problem of finding solutions using the modern technical method that encourages private investment. Paper type: Technical paper.

scholarly journals Post-discharge care following acute kidney injury: quality improvement in primary care

2020 ◽  
Vol 9 (4) ◽  
pp. e000891
Author(s):  
Susan J Howard ◽  
Rebecca Elvey ◽  
Julius Ohrnberger ◽  
Alex J Turner ◽  
Laura Anselmi ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Patient Safety ◽  
Quality Improvement ◽  
Health Outcomes ◽  
Kidney Injury ◽  
Audit And Feedback ◽  
Improvement Project ◽  
General Practices ◽  
The Impact

BackgroundOver the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI.DesignWe conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI.ResultsAKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality.ConclusionThe findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.

scholarly journals Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices

2021 ◽  
Vol 19 (6) ◽  
pp. 499-506
Author(s):  
Katie F. Coleman ◽  
Chloe Krakauer ◽  
Melissa Anderson ◽  
LeAnn Michaels ◽  
David A. Dorr ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Clinical Performance ◽  
Small Primary ◽  
Care Practices ◽  
Primary Care Practices
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