Process evaluation of a data-driven quality improvement program within a cluster randomised controlled trial to improve coronary heart disease management in Australian primary care.
Nashid Hafiz, Karice Hyun, Qiang Tu, Andrew Knight, Charlotte Hespe, Clara K Chow, Tom Briffa, Robyn Gallagher, Christopher M Reid, David L Hare, Nicholas Zwar, Mark Woodward, Stephen Jan, Emily R Atkins, Tracey-Lea Laba, Elizabeth Halcomb, Tracey Johnson, Deborah Manandi, Tim Usherwood, Julie Redfern
Author Information
Nashid Hafiz: School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia. ORCID
Karice Hyun: School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Qiang Tu: School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Andrew Knight: Primary and Integrated Care Unit, Southwestern Sydney Local Health District, Sydney, Australia. ORCID
Charlotte Hespe: The University of Notre Dame, School of Medicine, Sydney, Australia.
Clara K Chow: Western Sydney Local Health District, Sydney, Australia.
Tom Briffa: School of Population and Global Health, The University of Western Australia, Perth, Australia.
Robyn Gallagher: Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Christopher M Reid: School of Population Health, Curtin University, Perth, Australia. ORCID
David L Hare: University of Melbourne and Austin Health, Melbourne, Australia.
Nicholas Zwar: Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
Mark Woodward: The George Institute for Global Health, University of New South Wales, Sydney, Australia.
Stephen Jan: The George Institute for Global Health, University of New South Wales, Sydney, Australia.
Emily R Atkins: Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Westmead, Australia.
Tracey-Lea Laba: Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
Elizabeth Halcomb: School of Nursing, University of Wollongong, Wollongong, Australia.
Tracey Johnson: Inala Primary Care, Brisbane, Queensland, Australia.
Deborah Manandi: School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Tim Usherwood: Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Westmead, Australia.
Julie Redfern: School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
BACKGROUND: This study evaluates primary care practices' engagement with various features of a quality improvement (QI) intervention for patients with coronary heart disease (CHD) in four Australian states. METHODS: Twenty-seven practices participated in the QI intervention from November 2019 -November 2020. A combination of surveys, semi-structured interviews and other materials within the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease (QUEL) study were used in the process evaluation. Data were summarised using descriptive statistical and thematic analyses for 26 practices. RESULTS: Sixty-four practice team members and Primary Health Networks staff provided feedback, and nine of the 63 participants participated in the interviews. Seventy-eight percent (40/54) were either general practitioners or practice managers. Although 69% of the practices self-reported improvement in their management of heart disease, engagement with the intervention varied. Forty-two percent (11/26) of the practices attended five or more learning workshops, 69% (18/26) used Plan-Do-Study-Act cycles, and the median (Interquartile intervals) visits per practice to the online SharePoint site were 170 (146-252) visits. Qualitative data identified learning workshops and monthly feedback reports as the key features of the intervention. CONCLUSION: Practice engagement in a multi-featured data-driven QI intervention was common, with learning workshops and monthly feedback reports identified as the most useful features. A better understanding of these features will help influence future implementation of similar interventions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.
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