how to make quality improvement science acceptable and successful in primary care lessons from a 10...
TRANSCRIPT
How to make quality improvement science acceptable and successful in primary care
Lessons from a 10 year project in Australia
Andrew Knight
April 2014
ConflictsClinical Advisor to the Improvement FoundationShared funding to attend between IF and role as staff specialist
AcknowledgementsThe Australian Primary Care Collaboratives program is funded by the
Australian Government and conducted by the Improvement FoundationColleagues – Dale Ford and many others who have contributed since 2004.
Plan
1. Explain what we have doneThe problemThe selected solutionWhat happenedLessons
2. Ask you reflect and discussAre there lessons for your health system?
The Problem
1. Strengthening primary care…but how?2. General Practice in Australia
• 85% of population per year (March 2013)• 6.57 visits on average• 2.44 million encounters per week• 7035 practices (2011)• First contact, gatekeeper• No contract, universal insurance• Fee for service and some process incentives (10% income)
Reflection
Does your primary care system resemble ours?
The Solution
Quality Improvement Collaboratives
‘A Breakthrough Series Collaborative is a short-term (6 to15 month) learning system that brings together a large number of teams from hospitals or clinics to seek improvement in a focused topic area.’
IHI White Paper.
Breakthrough Collaborative Series
7
What we did
Small teams - 18 months3 workshops – aims, evidence, improvement, change principles, measuresActivity periods – PDSA cycles, measures, Monthly reports and cohort comparisonsLocal supportSharing of ideas
What happened
Based on NPDT, Sir John OldhamTransferred 2004 and we are still doing itMultiple overlapping cohorts - national Total services participating 1949 (unique 1230 approx. 18% of
total)Diabetes registers 302536CHD registers 177740COPD registers 41816PDSAS 36000
What happened
Access, diabetes, CHDPreventionCOPD Patient self managementDiabetes preventionAboriginal healthE health
Quality Improvement training
Chronic Kidney DiseasePatient safetyCancer screening
What happened
Local workshops –206 health services joined one of 15 locally based QI Collaboratives delivered by their support organisation. Virtual workshops- 60 health services joined one of four online QI Collaboratives delivered by IF. Medicare Local QIP - 359 health services joined their Medicare Locals in locally based QI workshops delivered by their Medicare Local.
What happened –Hba1c
Mean percentage of patients with an HbA1C ≤ 7% n-743
What happened – HbA1C recorded
Mean percentage of patients on register with HbA1C results recorded
What happened – cholesterol in CHD
Mean percentage of patients with cholesterol at target
What happened – spirometry in COPD
Mean percentage of patients with spirometry recorded
What happened – system change
Data extraction toolData management portalCulture change• knowledge, skills, attititudesSpread• National KPI reporting• Aboriginal medical services
Lessons - transfer
Not for profit• Independence, nimblenessAdjust to local needs…politicsRigour • structured
• sharing of intellectual propertyExpensive
Lessons - Evaluation
Built (budgeted) from the start• Publish
Knight AW, Caesar C, Ford D, Coughlin A, Frick C. Improving primary care inAustralia through the Australian Primary Care Collaboratives Program: a qualityimprovement report. BMJ Qual Saf. 2012 Jul 18.
Knight AW, Ford D, Audehm R, Colagiuri S, Best J. The Australian Primary
Care Collaboratives Program: improving diabetes care. BMJ Qual Saf. 2012 Jun 16.
Lessons - QICs
One collaborative• Short sharp effective• Achieve improved care• Provide training in
improvement
TEND to MEAN
Many collaboratives• Changed culture• Increased capacity• Changed expectations
SUSTAINABLE CHANGE?
NOT ENOUGH
Lessons - QICs
What works?Importance of team• In the literature (Ovretveit)• In Australia
• Team principleRight topicLocal support
Lessons - QICs
Engage with many small organisations• Known and trusted• Builds capacity• Adaptable• Limited
Lessons - QICs
Practice Context
Charlotte Hespe
Reflection
Would it work in your primary care system?•Introduce yourself to some people you don’t know•Share your reactions to our experience
• What would work• What wouldn’t work• What will you try