How to make quality improvement science acceptable and successful in primary care Lessons from 10 years of work in Australia - PowerPoint PPT Presentation

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How to make quality improvement science acceptable and successful in primary care Lessons from 10 years of work in Australia

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How to make quality improvement science acceptable and successful in primary care Lessons from 10 years of work in Australia Andrew Knight April 2014 – PowerPoint PPT presentation

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Title: How to make quality improvement science acceptable and successful in primary care Lessons from 10 years of work in Australia


1
How to make quality improvement science
acceptable and successful in primary
care Lessons from 10 years of work in Australia
  • Andrew Knight

2
  • Conflicts
  • Clinical Advisor to the Improvement Foundation
  • Shared funding to attend between IF and role as
    staff specialist
  • Acknowledgements
  • The Australian Primary Care Collaboratives
    program is funded by the Australian Government
    and conducted by the Improvement Foundation
  • Colleagues Dale Ford and many others who have
    contributed since 2004.

3
Plan
  • Explain what we have done
  • The problem
  • The selected solution
  • What happened
  • Lessons
  • Ask you reflect and discuss
  • Are there lessons for your health system?

4
The Problem
  • Strengthening primary carebut how?
  • 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)

5
Reflection
  • Does your primary care system resemble ours?

6
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.

7
Breakthrough Collaborative Series
8
What we did
  • Small teams - 18 months
  • 3 workshops aims, evidence, improvement, change
    principles, measures
  • Activity periods PDSA cycles, measures,
  • Monthly reports and cohort comparisons
  • Local support
  • Sharing of ideas

9
What happened
  • Based on NPDT, Sir John Oldham
  • Transferred 2004 and we are still doing it
  • Multiple overlapping cohorts - national
  • Total services participating 1949 (unique 1230
    approx. 18 of total)
  • Diabetes registers 302536
  • CHD registers 177740
  • COPD registers 41816
  • PDSAS 36000

10
What happened
  • Access, diabetes, CHD
  • Prevention
  • COPD
  • Patient self management
  • Diabetes prevention
  • Aboriginal health
  • E health
  • Quality Improvement training
  • Chronic Kidney Disease
  • Patient safety
  • Cancer screening

11
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.  
12
What happened Hba1c
Mean percentage of patients with an HbA1C 7
n-743
13
What happened HbA1C recorded
Mean percentage of patients on register with
HbA1C results recorded
14
What happened cholesterol in CHD
Mean percentage of patients with cholesterol at
target
15
What happened spirometry in COPD
Mean percentage of patients with spirometry
recorded
16
What happened plans in chronic disease
Mean percentage of patients with care plan
recorded
17
What happened system change
  • Data extraction tool
  • Data management portal
  • Culture change
  • knowledge, skills, attititudes
  • Spread
  • National KPI reporting
  • Aboriginal medical services

18
Lessons - transfer
  • Not for profit
  • Independence, nimbleness
  • Adjust to local needspolitics
  • Rigour
  • structured
  • sharing of intellectual property
  • Expensive

19
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.

20
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
21
Lessons - QICs
  • What works?
  • Importance of team
  • In the literature (Ovretveit)
  • In Australia
  • Team principle
  • Right topic
  • Local support

22
Lessons - QICs
  • Engage with many small organisations
  • Known and trusted
  • Builds capacity
  • Adaptable
  • Limited

23
Lessons - QICs
  • Practice Context
  • Charlotte Hespe

24
Reflection
  • Would it work in your primary care system?
  • Introduce yourself to some people you dont know
  • Share your reactions to our experience
  • What would work
  • What wouldnt work
  • What will you try
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