scholarly journals Learning from the Implementation of a Quality Improvement Intervention in Australian General Practice: A Qualitative Analysis of a CVD Preventive Care Project

2021 ◽  
Author(s):  
Charlotte Hespe ◽  
Edwina Brown ◽  
Lucie Rychetnik
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Care ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Full Potential ◽  
Australian General Practice ◽  
General Practices

Abstract BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.

scholarly journals The influence of funding models on collaboration in Australian general practice

2017 ◽  
Vol 23 (1) ◽  
pp. 31 ◽  
Author(s):  
Susan McInnes ◽  
Kath Peters ◽  
Andrew Bonney ◽  
Elizabeth Halcomb
Keyword(s):  
General Practice ◽  
Registered Nurses ◽  
General Practitioners ◽  
Clinical Care ◽  
Fee For Service ◽  
Naturalistic Inquiry ◽  
Face To Face ◽  
Australian General Practice ◽  
Working Together ◽  
General Practices

Despite more nurses working in Australian general practice, there has been limited investigation exploring ways that general practitioners and registered nurses work together to deliver clinical care. However, it has been postulated that the small business structure, common in Australian general practices, might influence collaboration between these two groups of health professionals. This paper presents one theme from a larger qualitative study. Eight general practitioners and fourteen registered nurses working in general practice participated in semistructured face-to-face interviews between February and May 2015. Naturalistic inquiry was adopted to elicit and explore the narrative accounts of participants about working together in general practice. An inductive process of thematic analysis was used to identify, analyse and report patterns and themes. Ancillary costs associated with the employment of registered nurses in general practice and the time registered nurses took to undertake procedural services were a concern for general practitioners. Registered nurses did not always work to their full scope of practice and many felt that their expertise was not appropriately remunerated. Findings suggested that fee for service-funding models can negatively influence collaboration between general practitioners and registered nurses working in general practice.

scholarly journals Motivations for the Adoption of Chronic Disease Information Systems in General Practice

2009 ◽  
Vol 4 (1) ◽  
Author(s):  
Daniel Carbone ◽  
Stephen Burgess
Keyword(s):  
Risk Management ◽  
General Practice ◽  
Information Systems ◽  
Patient Care ◽  
Financial Incentives ◽  
Successful Implementation ◽  
Care Gap ◽  
Disease Information ◽  
General Practices

The purpose of this paper is to highlight the key motivational factors that lead to the successful implementation of Chronic Diseases Information Systems (CDISs) in twenty eight general practices in a case study of a large general practice division network in Australia. The literature identified three major areas of CDIS motivation: patient care gap motivator, internal motivators and external motivators. Patient care emerged as the most important motivation for adopting CDIS, followed by risk management and financial incentives. However, the study also determined that the motivational forces are inter-related and suggests that the decision to adopt CDIS should consider a number of these identified factors.

scholarly journals Evaluating the Implementation of a Pilot Quality Improvement Program to Support Appropriate Antimicrobial Prescribing in General Practice

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 867
Author(s):  
Ruby Biezen ◽  
Kirsty Buising ◽  
Tim Monaghan ◽  
Rachael Ball ◽  
Karin Thursky ◽  
...  
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Improvement Program ◽  
Antimicrobial Prescribing ◽  
Australian General Practice ◽  
Practice Approach ◽  
General Practices

Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs’ decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a “whole of practice” approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice

2013 ◽  
Vol 19 (2) ◽  
pp. 150 ◽  
Author(s):  
Diann S. Eley ◽  
Elizabeth Patterson ◽  
Jacqui Young ◽  
Paul P. Fahey ◽  
Chris B. Del Mar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Models Of Care ◽  
Practice Nurses ◽  
Australian General Practice ◽  
General Practices

The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model’s feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients’ stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

scholarly journals Quality and general practice accreditation: The approach of Australian General Practice Accreditation Limited

1999 ◽  
Vol 22 (4) ◽  
pp. 161 ◽  
Author(s):  
Rob Pegram ◽  
David Wright
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Continuous Quality ◽  
Australian General Practice

The purpose of this article is to outline the underlying assumptions, principles and processes of a continuous quality improvement approach which underpins the accreditation of general practice offered by Australian General Practice Accreditation Limited.

scholarly journals The AgED Study. Age-related eye disease (AgED) in South Australian general practice: are we blind to early detection and intervention?

2017 ◽  
Vol 23 (1) ◽  
pp. 75 ◽  
Author(s):  
Chelsea Guymer ◽  
Robert Casson ◽  
Cate Howell ◽  
Nigel Stocks
Keyword(s):  
General Practice ◽  
Population Based ◽  
Postal Questionnaire ◽  
Eye Disease ◽  
Cross Sectional ◽  
Age Related ◽  
Retrospective Audit ◽  
Australian General Practice ◽  
Related Quality ◽  
General Practices

The AgED Study aimed to evaluate the detection, awareness and management of age-related eye disease (AgED) in South Australian general practice. Three South Australian metropolitan general practices were recruited and all patients aged 75 years and older were invited to participate. A cross-sectional postal questionnaire and retrospective audit of consenting patients’ medical records was performed. On average, patients had their last eye check 9 months ago; the majority (64.9%) performed by an optometrist. Only 7.6% had visited their GP for their last eye check, mostly (90.5%) for a mandatory ‘Fitness to Drive’ medical assessment. There were marked differences in GP recording v. self-reported AgED and a marked discrepancy in the prevalence rates of AgED, visual impairment and blindness in this study compared with Australian population-based prevalence surveys. Despite the lack of GP documentation of eye disease, the majority of patients engaged in timely eye checks with either an optometrist or ophthalmologist, and their overall visual function and vision-related quality of life (QoL) were satisfactory.

scholarly journals Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management

2018 ◽  
Vol 28 (3) ◽  
pp. 215-222 ◽  
Author(s):  
JoAnna K Leyenaar ◽  
Christine B Andrews ◽  
Emily R Tyksinski ◽  
Eric Biondi ◽  
Kavita Parikh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Clinical Care ◽  
Quality Measures ◽  
Community Acquired Pneumonia ◽  
Categorical Variables ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Narrow Spectrum ◽  
Clinical Departments

BackgroundEmergency medicine and paediatric hospital medicine physicians each provide a portion of the initial clinical care for the majority of hospitalised children in the USA. While these disciplines share goals to increase quality of care, there are scant data describing their collaboration. Our national, multihospital learning collaborative, which aimed to increase narrow-spectrum antibiotic prescribing for paediatric community-acquired pneumonia, provided an opportunity to examine factors influencing the success of quality improvement efforts across these two clinical departments.ObjectiveTo identify barriers to and facilitators of interdepartmental quality improvement implementation, with a particular focus on increasing narrow-spectrum antibiotic use in the emergency department and inpatient settings for children hospitalised with pneumonia.MethodsWe used a mixed-methods design, analysing interviews, written reports and quality measures. To describe hospital characteristics and quality measures, we calculated medians/IQRs for continuous variables, frequencies for categorical variables and Pearson correlation coefficients. We conducted in-depth, semistructured interviews by phone with collaborative site leaders; interviews were transcribed verbatim and, with progress reports, analysed using a general inductive approach.Results47 US-based hospitals were included in this analysis. Qualitative analysis of 35 interview transcripts and 142 written reports yielded eight inter-related domains that facilitated successful interdepartmental quality improvement: (1) hospital leadership and support, (2) quality improvement champions, (3) evidence supporting the intervention, (4) national health system influences, (5) collaborative culture, (6) departments’ structure and resources, (7) quality improvement implementation strategies and (8) interdepartmental relationships.ConclusionsThe conceptual framework presented here may be used to identify hospitals’ strengths and potential barriers to successful implementation of quality improvement efforts across clinical departments.

Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence

2010 ◽  
Vol 193 (10) ◽  
pp. 602-607 ◽  
Author(s):  
Christine B Phillips ◽  
Christopher M Pearce ◽  
Sally Hall ◽  
Joanne Travaglia ◽  
Simon Lusignan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Clinical Governance ◽  
Australian General Practice

scholarly journals Real-World Integration of a Sepsis Deep Learning Technology Into Routine Clinical Care: Implementation Study

10.2196/15182 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e15182 ◽  
Author(s):  
Mark P Sendak ◽  
William Ratliff ◽  
Dina Sarro ◽  
Elizabeth Alderton ◽  
Joseph Futoma ◽  
...  
Keyword(s):  
Machine Learning ◽  
Quality Improvement ◽  
Deep Learning ◽  
Health System ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Quality Improvement Effort ◽  
Management Platform ◽  
Routine Clinical Care ◽  
Improvement Effort

Background Successful integrations of machine learning into routine clinical care are exceedingly rare, and barriers to its adoption are poorly characterized in the literature. Objective This study aims to report a quality improvement effort to integrate a deep learning sepsis detection and management platform, Sepsis Watch, into routine clinical care. Methods In 2016, a multidisciplinary team consisting of statisticians, data scientists, data engineers, and clinicians was assembled by the leadership of an academic health system to radically improve the detection and treatment of sepsis. This report of the quality improvement effort follows the learning health system framework to describe the problem assessment, design, development, implementation, and evaluation plan of Sepsis Watch. Results Sepsis Watch was successfully integrated into routine clinical care and reshaped how local machine learning projects are executed. Frontline clinical staff were highly engaged in the design and development of the workflow, machine learning model, and application. Novel machine learning methods were developed to detect sepsis early, and implementation of the model required robust infrastructure. Significant investment was required to align stakeholders, develop trusting relationships, define roles and responsibilities, and to train frontline staff, leading to the establishment of 3 partnerships with internal and external research groups to evaluate Sepsis Watch. Conclusions Machine learning models are commonly developed to enhance clinical decision making, but successful integrations of machine learning into routine clinical care are rare. Although there is no playbook for integrating deep learning into clinical care, learnings from the Sepsis Watch integration can inform efforts to develop machine learning technologies at other health care delivery systems.

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