Elsevier

Health Policy

Volume 119, Issue 4, April 2015, Pages 405-416
Health Policy

Impact of a quality improvement program on primary healthcare in Canada: A mixed-method evaluation

https://doi.org/10.1016/j.healthpol.2014.10.019Get rights and content
Under a Creative Commons license
open access

Highlights

  • No between group diabetes (A1c, foot exams) outcomes were statistically different.

  • Colorectal cancer screening rates between groups were not statistically different.

  • Advanced access between groups was not statistically different.

  • Interdisciplinary team functioning and capacity improved.

  • Quantitative improvements over time in both groups likely explains the results.

  • Policy makers must endorse programs with proven success through rigorous evaluation.

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.

Keywords

Primary healthcare
Quality improvement
Interdisciplinary teams
Diabetes
Colorectal cancer screening
Advanced access
Evaluation

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