The evaluation of the Plan-Do-Study-Act cycles for a healthcare quality improvement intervention in primary care

被引:3
作者
Manandi, Deborah [1 ]
Tu, Qiang [1 ]
Hafiz, Nashid [1 ]
Raeside, Rebecca [1 ]
Redfern, Julie [1 ,2 ]
Hyun, Karice [1 ,3 ]
机构
[1] Univ Sydney, Fac Med & Hlth, Sch Hlth Sci, Sydney, NSW 2050, Australia
[2] Univ New South Wales, George Inst Global Hlth, Sydney, NSW 2042, Australia
[3] Concord Repatriat Gen Hosp, ANZAC Res Inst, Dept Cardiol, Sydney, NSW 2139, Australia
基金
澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;
关键词
cardiovascular disease; chronic disease; coronary heart disease; general practice; PDSA; Plan-Do-Study-Act cycles; primary care; quality improvement; secondary prevention;
D O I
10.1071/PY23123
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background The Plan-Do-Study-Act (PDSA) cycle is an iterative framework that has been gaining traction in primary care for quality improvement. However, its implementation remains understudied. This study evaluated the completion, achievement of goal, content quality, and enablers and barriers associated with completion of high-quality PDSA cycles in cardiovascular disease management in general practices.Methods This study analysed data from intervention practices of the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living people with coronary heart disease (QUEL) study. Content quality of cycles was assessed using a scoring system created based on established criteria of ideal PDSA cycles in the healthcare context. Practice-level factors associated with completion and cycles achieving the planned goal were explored through logistic regression models, and with content quality score through linear regression model. Enablers and barriers were assessed using thematic analysis of practices' responses to the PDSA sections.Results Ninety-seven cycles were reported by 18/26 (69%) practices. Seventy-seven percent of the cycles were completed and 68% achieved the planned goal. Content quality was low, with a median score of 56% (interquartile interval: 44%, 67%). Odds of cycles that were completed and achieved what was planned increased by 3.6- and 9.6-fold, respectively, with more general practitioners (GPs) within practices. Content quality was higher by 15% with more GPs. Lack of interprofessional engagement was a barrier to implementation.Conclusions Cycles were well completed, but poor in content quality, with high variability between practices. Human or capital resources and organisational support may be critical for the completion and cycles achieving the planned goals. Plan-Do-Study-Act (PDSA) cycles are increasingly used as a framework for improving quality of health care, yet its utility in primary care practices have remained largely understudied. PDSA cycles reported by general practices were high in completion, successful and achieved improvement, but low in content quality. Completion, success and content quality of PDSA cycles were likely influenced by human or capital resources availability and training provided to general practices.
引用
收藏
页数:9
相关论文
共 36 条
[1]  
Ali MA, 2017, INDIAN HEART J, V69, P469, DOI 10.1016/j.ihj.2017.05.017
[2]  
[Anonymous], 2012, Quality improvement training for healthcare professionals The Health Foundation Inspiring Improvement Evidence Centre
[3]  
[Anonymous], 2003, The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement
[4]  
Australian Institute of Health and Welfare, 2023, Heart, stroke and vascular disease: Australian facts Web report (Internet)
[5]   Quality improvement into practice [J].
Backhouse, Adam ;
Ogunlayi, Fatai .
BMJ-BRITISH MEDICAL JOURNAL, 2020, 368
[6]   Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments [J].
Ben-Assuli, Ofir .
HEALTH POLICY, 2015, 119 (03) :287-297
[7]  
Braun V, 2006, Qualitative Research in Psychology, V3, P77, DOI [DOI 10.1191/1478088706QP063OA, 10.1191/1478088706qp063oa, DOI 10.1080/14780887.2020.1769238]
[8]   Demystifying theory and its use in improvement [J].
Davidoff, Frank ;
Dixon-Woods, Mary ;
Leviton, Laura ;
Michie, Susan .
BMJ QUALITY & SAFETY, 2015, 24 (03) :228-238
[9]   Using Electronic Clinical Decision Support in Patient-Centered Medical Homes to Improve Management of Diabetes in Primary Care The DECIDE Study [J].
Gill, James ;
Kucharski, Kathrin ;
Turk, Barbara ;
Pan, Chunshen ;
Wei, Wenhui .
JOURNAL OF AMBULATORY CARE MANAGEMENT, 2019, 42 (02) :105-115
[10]   Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers [J].
Gosling, Jennifer ;
Mays, Nicholas ;
Erens, Bob ;
Reid, David ;
Exley, Josephine .
BMJ OPEN QUALITY, 2021, 10 (02)