Dataset Information

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

ABSTRACT:

Purpose

We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease.

Methods

A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point Quality Improvement Capacity Assessment (QICA). Clinics reported performance on 3 cardiovascular CQMs-appropriate aspirin use, blood pressure (BP) control (<140/90 mm Hg), and smoking screening/cessation counseling-at baseline (2015) and follow-up (2017). Regression analyses with change in CQM as the dependent variable allowed for clustering by practice facilitator and adjusted for baseline CQM performance.

Results

Practices improved QICA scores by 1.44 points (95% CI, 1.20-1.68; P <.001) from an average baseline of 6.45. All 3 CQMs also improved: aspirin use by 3.98% (average baseline = 66.8%; 95% CI for change, 1.17%-6.79%; P = .006); BP control by 3.36% (average baseline = 61.5%; 95% CI for change, 1.44%-5.27%; P = .001); and tobacco screening/cessation counseling by 7.49% (average baseline = 73.8%; 95% CI for change, 4.21%-10.77%; P <.001). Each 1-point increase in QICA score was associated with a 1.25% (95% CI, 0.41%-2.09%, P = .003) improvement in BP control; the estimated likelihood of reaching a 70% BP control performance goal was 1.24 times higher (95% CI, 1.09-1.40; P <.001) for each 1-point increase in QICA.

Conclusion

Improvements in clinic-level performance on BP control may be attributed to implementation of 7 evidence-based strategies to build quality improvement capacity. These strategies were feasible to implement in small practices over 15 months.

SUBMITTER: Coleman KF

PROVIDER: S-EPMC8575517 | biostudies-literature | 2021 Nov-Dec

REPOSITORIES: biostudies-literature

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Publications

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

Coleman Katie F KF Krakauer Chloe C Anderson Melissa M Michaels LeAnn L Dorr David A DA Fagnan Lyle J LJ Hsu Clarissa C Parchman Michael L ML

Annals of family medicine 20211101 6

<h4>Purpose</h4>We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease.<h4>Methods</h4>A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point ...[more]

PMID: 34750124

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Project description:BackgroundPrimary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC - primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support.MethodsThis study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts.ResultsResults of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = - 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts.ConclusionDistrict level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.

Dataset Information

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

Purpose

Methods

Results

Conclusion

Publications

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

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