CQI Cohorts for Primary Care Improvement

Not currently recruiting at 22 trial locations

Overseen By Elisabeth Martin, Ph.D(c)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Université de Sherbrooke

Disqualifiers: Solo practice, Physician-nurse model

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method called Continuous Quality Improvement (CQI) to evaluate its impact on services at primary healthcare clinics. It examines how effectively clinics can enhance access to care through repeated CQI activities. Clinics will either implement this new CQI method or continue with their current Audit and Feedback system. This trial suits clinics that offer team-based care with diverse professionals and have at least half of the team willing to participate. As an unphased trial, it provides a unique opportunity to contribute to innovative healthcare improvements.

Do I need to stop my current medications for this trial?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that these methods are safe for primary healthcare clinics?

Research has shown that Continuous Quality Improvement (CQI) is generally safe and well-tolerated. CQI gradually improves processes, particularly in healthcare, to enhance safety and patient care. Studies indicate that applying CQI in healthcare can lead to better outcomes without causing harm. It involves regular, small improvements based on data, maintaining safety and effectiveness. No reports have linked CQI itself to negative effects. Participants can therefore feel confident about the safety of this approach. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the CQI intervention for primary care improvement because it focuses on a continuous quality improvement approach, rather than just providing feedback. Unlike traditional methods, which might only offer periodic updates, this intervention involves ongoing activities that are repeated until specific improvement goals are met. This iterative process allows for more dynamic adjustments and continuous enhancement of care practices, potentially leading to more significant and sustained improvements in patient outcomes.

What evidence suggests that this trial's treatments could be effective for improving AA outcomes?

Research shows that Continuous Quality Improvement (CQI), which participants in this trial may receive, can enhance healthcare services. Studies have found that CQI involves small, ongoing improvements in healthcare delivery, enhancing patient safety and overall care quality. In primary care clinics, CQI has been linked to better service and improved health outcomes. Evidence also suggests that when healthcare teams use CQI, it improves provider performance and leads to better patient results. While CQI doesn't treat a specific disease, it aims to make healthcare delivery more effective, leading to better patient experiences and outcomes. ^{1 4 6 7 8}

Who Is on the Research Team?

Mylaine Breton, PhD

Principal Investigator

Université de Sherbrooke

Are You a Good Fit for This Trial?

This trial is for primary healthcare clinics where at least half of the team agrees to participate. The clinic must provide care from a variety of health professionals, not just doctors and nurses. Solo practice physicians or clinics with only physician-nurse models cannot join.

Inclusion Criteria

Clinics must offer interprofessional care

At least 50% of all team members should accept to take part in the study

Exclusion Criteria

Solo Practice Physicians

Physician-nurse only model

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

PHC teams participate in an externally facilitated CQI program focusing on advanced access, consisting of interprofessional reflective sessions, group mentoring, and cohort cross-learning exchange opportunities.

18 months

Control Group Audit

Clinics in the control group receive feedback on six key advanced access indicators and patient-reported experiences about access.

12-18 months

Follow-up

Participants are monitored for outcomes such as the delay before the 3rd next available appointment, relational continuity, and use of walk-in services.

18 months

What Are the Treatments Tested in This Trial?

Interventions

• Audit and Feedback
• CQI intervention

Trial Overview The study is examining how effective Continuous Quality Improvement (CQI) cohorts are in improving access to primary healthcare services. It involves monitoring performance (audit) and providing feedback, alongside CQI interventions.

How Is the Trial Designed?

Group I: CQI intervention Experimental Treatment 1 Intervention

The proposed CQI cohort consists of three activities carried out iteratively until the improvement objectives are achieved.

Group II: Audit and feedback Active Control 1 Intervention

Clinics in the control group will receive feedback on six key AA indicators, patients reported experience about access and selected AA processes.

Who Is Running the Clinical Trial?

Université de Sherbrooke

Lead Sponsor

Trials

317

Recruited

79,300+

Isabelle Gaboury

Collaborator

Trials

1

Recruited

50+

Mike Green

Collaborator

Trials

1

Recruited

50+

Tara Kiran

Collaborator

Trials

1

Recruited

50+

Janusz Kaczorowski

Collaborator

Trials

1

Recruited

50+

Maude Laberge

Collaborator

Trials

1

Recruited

50+

Published Research Related to This Trial

The team-based model for continuous quality improvement (CQI) significantly increased the number of defined improvement objectives in primary care practices, with 93 objectives set in the intervention group compared to 54 in the control group (P<0.001).

The intervention group also had a higher success rate in completing improvement projects (80% vs. 69%), indicating that structured support can enhance the effectiveness of quality improvement initiatives in primary care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial. Engels, Y., van den Hombergh, P., Mokkink, H., et al.[2018]

The implementation of a continuous quality improvement (CQI) intervention in a primary care clinic led to a significant reduction in mean HbA1c levels from 8.9% to 7.9% over 18 months, indicating improved glycemic control for patients with diabetes.

Patients at the CQI intervention clinic had a higher proportion of individuals achieving HbA1c levels of 8% or less (51%) compared to a similar clinic without the intervention (40%), demonstrating the effectiveness of CQI in enhancing diabetes management without increasing healthcare utilization or costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuous quality improvement can improve glycemic control for HMO patients with diabetes. O'Connor, PJ., Rush, WA., Peterson, J., et al.[2022]

The GEDAPS quality improvement program in Catalonia, implemented from 1993 to 2002, led to significant improvements in diabetes care outcomes for both urban and rural populations, with rural areas showing similar or better results than urban areas by 2002.

The program also benefited hard-to-reach groups, such as older individuals (≥75 years), who experienced equal or better improvements in health outcomes compared to younger individuals (≤74 years), suggesting that a universal approach can effectively enhance care across diverse populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of a programme to improve quality of care for people with type 2 diabetes on hard to reach groups: The GEDAPS study. Bodicoat, DH., Mundet, X., Davies, MJ., et al.[2022]

In a study analyzing data from 69,682 patients across 25 NHS practices, adverse events such as injuries from medical care and adverse drug reactions were identified at rates of 0.72 and 1.26 per 1000 consultations, respectively.

The research highlights the potential for using electronic health records to improve patient safety surveillance in primary care, suggesting that systematic monitoring could lead to better detection and management of adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recording of adverse events in English general practice: analysis of data from electronic patient records. Tsang, C., Majeed, A., Banarsee, R., et al.[2019]

The quality improvement (QI) intervention was successfully implemented in 12 primary care clinics, leading to increased staff participation in QI activities and better use of patient registries, which are important for managing diabetes care.

Despite these improvements in process, the intervention did not result in significant changes in clinical outcomes such as A1C, LDL, or blood pressure levels, indicating that future QI efforts should focus more on specific clinical actions like medication adjustments and engaging patients more actively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized trial of quality improvement intervention to improve diabetes care in primary care settings. O'Connor, PJ., Desai, J., Solberg, LI., et al.[2019]

A study of 229 general practices found that high-quality primary care, including better access to preferred doctors and effective management of cholesterol levels, is linked to lower rates of premature coronary heart disease (CHD) mortality.

Improving the quality of CHD care from 83% to 86% could potentially reduce premature CHD mortality by 3.6%, highlighting the importance of quality improvement in primary care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality. Honeyford, K., Baker, R., Bankart, MJ., et al.[2021]

A study analyzing electronic primary care data from 89 general practices in West Yorkshire, UK, found significant variations in the achievement of quality indicators (QIs) for managing conditions like diabetes and hypertension, with median achievement rates ranging from 43.2% to 72.2%.

The research highlighted that patient characteristics such as age and comorbidity had a modest impact on care quality, but much of the variation in care delivery remains unexplained, suggesting that differences in clinical and organizational behaviors are significant factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study. Willis, TA., West, R., Rushforth, B., et al.[2022]

In a study of 20 family practices in The Netherlands, physicians and staff generally had positive attitudes towards a tailored model of Continuous Quality Improvement (CQI), indicating a willingness to adopt and continue using it despite varying implementation rates.

Barriers to successful implementation included high workloads and a tendency to delay actions until external support was available, highlighting the need for manageable initial projects and addressing personal obstacles during the CQI introduction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff. Geboers, H., Mokkink, H., van Montfort, P., et al.[2019]

A review of systematic literature identified several effective quality improvement interventions in primary care practices, including audit and feedback, computerized advice, and practice facilitation, particularly beneficial when baseline performance is low.

While various interventions showed positive effects on care processes and prescribing measures, there was insufficient evidence to conclude that combining multiple interventions is more effective than using single strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice-level quality improvement interventions in primary care: a review of systematic reviews. Irwin, R., Stokes, T., Marshall, T.[2022]

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK559239/

Continuous Quality Improvement - StatPearls - NCBI Bookshelf Continuous Quality Improvement (CQI) is a progressive incremental improvement of processes, safety, and patient care.

2. bmchealthservres.biomedcentral.com bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10828-0

A scoping review of continuous quality improvement in ... Continuous quality improvement and comprehensive primary health care: a systems framework to improve service quality and health outcomes.

3. hsrd.research.va.gov hsrd.research.va.gov/publications/esp/continuous-qi-APP.pdf

Continuous Quality Improvement (CQI) for Clinical Teams Marshall, Practice-level quality improvement interventions in primary care: a review of systematic reviews. Primary Health Care Research & Development.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6486276/

Continuous quality improvement: effects on professional ... While the primary aim of this review is to determine the effect of team‐based CQI on healthcare provider performance and patient outcomes, CQI strategies have ...

5. cms.gov cms.gov/medicare/quality-initiatives-patient-assessment-instruments/mms/quality-measure-and-quality-improvement-

Quality Measurement and Quality Improvement Quality improvement is the framework used to systematically improve care. Quality improvement seeks to standardize processes and structure to reduce variation.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11031995/

A scoping review of continuous quality improvement in ... Continuous quality improvement and comprehensive primary health care: a systems framework to improve service quality and health outcomes.

7. implementationscience.biomedcentral.com implementationscience.biomedcentral.com/articles/10.1186/s13012-020-0975-2

The effectiveness of continuous quality improvement for ... This review assesses the effectiveness of CQI across different health care settings, investigating the importance of different components of the approach.

8. childwelfare.gov childwelfare.gov/topics/data-systems-and-organizational-improvement/continuous-quality-improvement-cqi/

Continuous Quality Improvement (CQI) CQI is a proactive, cyclical process that uses data to improve services and child welfare outcomes. Having a robust CQI system contributes to consistently ...