Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes

Abstract

BackgroundImproving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI).MethodsIn order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration.ResultsDuring the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care.DiscussionOur study results demonstrate that the COMPAS intervention enabled professionals to target priorities for practice improvements and to develop action plans that promote interprofessional collaboration. The COMPAS intervention aims to increase capability for continuous QI, readiness to implement process of care changes and team shared goals but available resources, climate and culture for change and leadership, are also important required conditions to successfully implement these practice changes.ConclusionWe think that the proposed approach can be very useful to support and engage primary care professionals in the planning stage of quality improvement projects since it combines key successful ingredients: feedback, reflection and planning of action.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1056-0) contains supplementary material, which is available to authorized users.

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“…The program's main goals were to engage primary care providers in continuous QI, improve interprofessional collaboration, and enhance the quality of care for priority chronic diseases [32]. The innovation central to COMPAS was the way in which it combined the use of population-based data to provide feedback on chronic disease performance, engaged participants in a process of critical reflection around their performance, and facilitated the development of QI action plans through a process of collaborative problem solving [32,33]. These components were delivered as part of a half-day continuing professional development workshop for primary care teams from a same territory.…”

“…These components were delivered as part of a half-day continuing professional development workshop for primary care teams from a same territory. COM-PAS integrated notions of the Chronic Care Model [34] and Model for Improvement [35] and was guided by a well-articulated program theory of change [32,33]. An evaluation of 10 workshops on diabetes management [33] revealed that COMPAS was effective in engaging participants and helping them recognize gaps between current practice and those outlined in clinical guidelines.…”

“…COM-PAS integrated notions of the Chronic Care Model [34] and Model for Improvement [35] and was guided by a well-articulated program theory of change [32,33]. An evaluation of 10 workshops on diabetes management [33] revealed that COMPAS was effective in engaging participants and helping them recognize gaps between current practice and those outlined in clinical guidelines. QI action plans very frequently targeted improvement of interprofessional collaboration and addressed areas such as primary and secondary prevention of diabetes, screening practices, supporting patient self-management, and enhancing patients' access to evidence-based treatments.…”

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