Stewart B Harris1, Michael E Green2, Judith Belle Brown3, Sharon Roberts4, Grant Russell5, Meghan Fournie6, Susan Webster-Bogaert7, Jann Paquette-Warren8, Jyoti Kotecha9, Han Han10, Amardeep Thind11, Moira Stewart12, Sonja Reichert13, Jordan W Tompkins14, Richard Birtwhistle15. 1. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: stewart.harris@schulich.uwo.ca. 2. Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: michael.green@dfm.queensu.ca. 3. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: judith.brown@schulich.uwo.ca. 4. Renison University College at the University of Waterloo, 240 Westmount Road North, Waterloo, Ontario Canada N2L 3G4. Electronic address: serobert@uwaterloo.ca. 5. Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill VIC, 3168, Australia. Electronic address: grant.russell@med.monash.edu.au. 6. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: meghan.fournie@schulich.uwo.ca. 7. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: susan.webster-bogaert@schulich.uwo.ca. 8. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: jann.paquette-warren@schulich.uwo.ca. 9. Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: jyoti.kotecha@cspc.queensu.ca. 10. Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: han.han@cspc.queensu.ca. 11. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, Room K201, London, Ontario, Canada. Electronic address: amardeep.thind@schulich.uwo.ca. 12. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: moira.stewart@schulich.uwo.ca. 13. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: sonja.reichert@schulich.uwo.ca. 14. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: jordan.tompkins@schulich.uwo.ca. 15. Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: richard.birtwhistle@dfm.queensu.ca.
Abstract
PURPOSE: Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement and Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning. METHODS: This article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: (1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; (2) post-only advanced access survey (third-next available appointment); and (3) post-only semi-structured interviews (team functioning). RESULTS: Chart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p=0.10]; foot exams [p=0.45]; CRC screening [p=0.77]; advanced access [p=0.22]). Qualitative interview (n=42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity. CONCLUSION: The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.
PURPOSE: Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement and Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning. METHODS: This article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: (1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; (2) post-only advanced access survey (third-next available appointment); and (3) post-only semi-structured interviews (team functioning). RESULTS: Chart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p=0.10]; foot exams [p=0.45]; CRC screening [p=0.77]; advanced access [p=0.22]). Qualitative interview (n=42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity. CONCLUSION: The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.
Authors: Michael E Green; Stewart B Harris; Susan Webster-Bogaert; Han Han; Jyoti Kotecha; Alexander Kopp; Minnie M Ho; Richard V Birtwhistle; Richard H Glazier Journal: CMAJ Open Date: 2017-04-06
Authors: Kimberly Wintemute; Michelle Greiver; Warren McIsaac; M Elisabeth Del Giudice; Frank Sullivan; Babak Aliarzadeh; Sumeet Kalia; Chris Meaney; Rahim Moineddin; Alexander Singer Journal: Can Fam Physician Date: 2019-11 Impact factor: 3.275
Authors: Sonja M Reichert; Stewart B Harris; Jordan W Tompkins; Judith Belle-Brown; Meghan Fournie; Michael Green; Han Han; Jyoti Kotecha; Selam Mequanint; Jann Paquette-Warren; Sharon Roberts; Grant Russell; Moira Stewart; Amardeep Thind; Susan Webster-Bogaert; Richard Birtwhistle Journal: BMJ Open Diabetes Res Care Date: 2017-08-29
Authors: Andrea Chambers; Cynthia Chen; Kevin Antoine Brown; Nick Daneman; Bradley Langford; Valerie Leung; Kwaku Adomako; Kevin L Schwartz; Julia E Moore; Jacquelyn Quirk; Sam MacFarlane; Tim Cronsberry; Gary E Garber Journal: BMJ Qual Saf Date: 2021-04-14 Impact factor: 7.035