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

doi:10.1371/journal.pone.0298777

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

PLoS One. 2024 Jun 4;19(6):e0298777. doi: 10.1371/journal.pone.0298777. eCollection 2024.

Authors

Nashid Hafiz¹, Karice Hyun^{1

2}, Qiang Tu¹, Andrew Knight^{3

4}, Charlotte Hespe⁵, Clara K Chow^{6

7}, Tom Briffa⁸, Robyn Gallagher⁹, Christopher M Reid^{10

11}, David L Hare¹², Nicholas Zwar¹³, Mark Woodward^{14

15}, Stephen Jan¹⁴, Emily R Atkins^{7

14}, Tracey-Lea Laba¹⁶, Elizabeth Halcomb¹⁷, Tracey Johnson¹⁸, Deborah Manandi¹, Tim Usherwood^{7

14}, Julie Redfern^{1

14}

Affiliations

¹ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
² Department of Cardiology, Concord Hospital, ANZAC Research Institute, Sydney, Australia.
³ Primary and Integrated Care Unit, Southwestern Sydney Local Health District, Sydney, Australia.
⁴ School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
⁵ The University of Notre Dame, School of Medicine, Sydney, Australia.
⁶ Western Sydney Local Health District, Sydney, Australia.
⁷ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Westmead, Australia.
⁸ School of Population and Global Health, The University of Western Australia, Perth, Australia.
⁹ Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹⁰ School of Population Health, Curtin University, Perth, Australia.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹² University of Melbourne and Austin Health, Melbourne, Australia.
¹³ Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
¹⁴ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹⁵ The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom.
¹⁶ Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
¹⁷ School of Nursing, University of Wollongong, Wollongong, Australia.
¹⁸ Inala Primary Care, Brisbane, Queensland, Australia.

Abstract

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.

Copyright: © 2024 Hafiz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Australia
Coronary Disease* / therapy
Disease Management
Female
Humans
Male
Primary Health Care*
Quality Improvement*

Grants and funding

Funding for this study was provided by a National Health and Medical Research Council (NHMRC) Partnership Project Grant (Award Grant Number: GNT1140807). Additional in-kind and cash support from the following partner organisations; Amgen (cash support), Austin Health, Australian Cardiovascular Health and Rehabilitation Association, Australian Commission on Safety and Quality in Health Care, Australian Primary Health Care Nurses Association, Brisbane South PHN, Fairfield General Practice Unit, Heart Support Australia, Improvement Foundation, Inala Primary Care, National Heart Foundation of Australia, Nepean Blue Mountains PHN (cash support), Royal Australian College of General Practitioners, Sanofi (provided cash support via the Externally Sponsored Collaboration pathway), South Western Sydney PHN, The George Institute for Global Health (cash support) and University of Melbourne. The funders, including funding body and industry partners had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.