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Journal ArticleDOI

Informing implementation of quality improvement in Australian primary care.

TL;DR: There are substantial opportunities for PHCOs to play a pivotal role in QI implementation in Australia and internationally and such organisations ought to invest their efforts in developing QI programs and policies.
Abstract: Quality Improvement (QI) initiatives in primary care are effective at improving uptake of evidence based guidelines, but are difficult to implement and sustain. In Australia meso-level health organisations such as Primary health care Organisations (PHCO) offer new opportunities to implement area-wide QI programs. This study sought to identify enablers and barriers to implementation of an existing Australian QI program and to identify strategic directions that PHCOs can use in the ongoing development of QI in this environment. Semi-structured telephone interviews were conducted with 15 purposively selected program staff and participants from the Australian Primary Care Collaborative (APCC) QI program. Interviewees included seven people involved in design, administration and implementation of the APCC program and eight primary care providers (seven General Practitioners (GPs) and one practice nurse) who had participated in the program from 2004 to 2014. Interviewees were asked to describe their experience of the program and reflect on what enabled or impeded its implementation. Interviews were recorded, transcribed and iteratively analysed, with early analysis informing subsequent interviews. Identified themes and their implications were reviewed by a GP expert reference group. Implementation enablers and barriers were grouped into five thematic areas: (1) leadership, particularly the identification and utilisation of change champions; (2) organisational culture that supports quality improvement; (3) funding incentives that support a culture of quality and innovation; (4) access to and use of accurate data; and 5) design and utilisation of clinical systems that enable and support these issues. In all of these areas, the active involvement of an overarching external support organisation was considered a key ingredient to successful implementation. There are substantial opportunities for PHCOs to play a pivotal role in QI implementation in Australia and internationally. In developing QI programs and policies, such organisations ought to invest their efforts in: (1) identifying and mentoring local leaders; (2) fostering QI culture via development of local peer networks; (3) developing and advocating for alternative funding models to support and incentivise these activities; (4) investing in data and audit tool infrastructure; and (5) facilitation of systems implementation within primary care practices.

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Citations
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Journal ArticleDOI
TL;DR: Introducing an AF screening program is likely to be successful in contexts where there is a senior GP ‘screening champion’, a clear protocol exists for abnormal results, and there is regular data reporting to staff.
Abstract: Screening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016–June 2019. These studies trialled custom-designed eHealth tools to support all stages of AF screening in general practice. A realist evaluation of the AF-SMART studies, which aimed to explain the circumstances in which the program worked (or not) to increase the proportion of people screened for AF. The initial program theory was based on our previous research, policy documents and screening studies. To test this, we conducted 45 semi-structured interviews with general practitioners (GPs), nurses and practice managers across all participating practices, and collected observational and quantitative screening data. These data were analysed and interpreted to refine the program theory. GPs/nurses liked the eHealth tools, although technical problems sometimes disrupted screening. Time was the main barrier to screening for GPs/nurses, so systems need to be very efficient. Practices with leadership from a senior GP ‘screening champion’ had broader uptake, especially from the nursing team. Providing regular feedback on screening data was beneficial for quality improvement and motivation. Clear protocols for follow-up of abnormal results were required for successful nurse-led screening in a hierarchical system. Participation in the program had broader benefits of improving AF knowledge and raising the profile of cardiovascular health in the practice. Screening for a shorter, more intense period (eg during influenza vaccination) worked well for practices where sufficient staff time was allocated. Introducing an AF screening program is likely to be successful in contexts where there is a senior GP ‘screening champion’, a clear protocol exists for abnormal results, and there is regular data reporting to staff. These contexts link to mechanisms around motivation, leadership, empowerment of nurses, and efficient screening systems. The contexts and mechanisms contribute to the longer-term outcomes of increasing the proportion of people screened and treated for AF, which is recommended by guidelines as a key strategy for the prevention of AF-related stroke. AF SMART (metropolitan): ACTRN12616000850471 (Australia New Zealand Clinical Trials Registry). AF SMART II (rural): ACTRN12618000004268 (Australia New Zealand Clinical Trials Registry).

17 citations

Journal ArticleDOI
TL;DR: It is demonstrated that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care.
Abstract: Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = − 8.98, P < 0.000), first contact-utilization(β = − 0.71,P < 0.001), first contact-accessibility(β = − 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = − 1.42, P < 0.001), comprehensiveness (utilization) (β = − 1.70, P < 0.001), comprehensiveness (provision) (β = − 0.99, P < 0.001),family-centeredness(β = − 0.52, P < 0.01), community orientation(β = − 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = − 0.25, P = 0.137) and culture orientation (β = − 0.264, P = 0.056) between the two both groups. This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.

17 citations


Cites background from "Informing implementation of quality..."

  • ...Evidence from many countries shows that the contract between physician and patient could improve the quality of primary care, and patients who have their usual source of care from their primary care doctors benefit most in health outcomes [9, 10]....

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Journal ArticleDOI
TL;DR: Two major categories emerged that confirm that although midwifery values evidence‐based practice (EBP), evidence‐informed maternity care is not always employed in clinical settings, and closure of the evidence‐to‐practice gap in maternity care requires a multidimensional approach.
Abstract: Aims and objectives To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care. Background Midwifery is a research-informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice. Design A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review. Methods The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub-categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question. Results The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence-based practice (EBP), evidence-informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence-to-practice gap in maternity care requires a multidimensional approach. Conclusion Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice. Relevance to clinical practice Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.

13 citations

Journal ArticleDOI
TL;DR: Wang et al. as discussed by the authors employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies to assess the determinants of primary health care (PHC) service preference among the residents and the trend in PHC service preference over time in China.
Abstract: Residents’ preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China. We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior. The results indicated that individuals’ socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents’ likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764–0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657–0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611–0.694) in 2018. The decrease was significantly associated with the changes in residents’ health status. The residents’ likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China’s National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals.

13 citations

ReportDOI
15 Oct 2020
TL;DR: This paper presents a summary of the main findings of a two-year research project into the determinants of infectious disease and its role in the immune system.
Abstract: .................................................................................................................................................. 3 Table of contents .................................................................................................................................... 5 Tables ...................................................................................................................................................... 7 Figures ..................................................................................................................................................... 8 Boxes ....................................................................................................................................................... 9 Supplementary Material Files ............................................................................................................... 10 Abbreviations ........................................................................................................................................ 11 Plain English summary .......................................................................................................................... 12 Scientific summary ................................................................................................................................ 13 Chapter 1: Context ................................................................................................................................ 2

13 citations

References
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Book
01 Jan 1962
TL;DR: A history of diffusion research can be found in this paper, where the authors present a glossary of developments in the field of Diffusion research and discuss the consequences of these developments.
Abstract: Contents Preface CHAPTER 1. ELEMENTS OF DIFFUSION CHAPTER 2. A HISTORY OF DIFFUSION RESEARCH CHAPTER 3. CONTRIBUTIONS AND CRITICISMS OF DIFFUSION RESEARCH CHAPTER 4. THE GENERATION OF INNOVATIONS CHAPTER 5. THE INNOVATION-DECISION PROCESS CHAPTER 6. ATTRIBUTES OF INNOVATIONS AND THEIR RATE OF ADOPTION CHAPTER 7. INNOVATIVENESS AND ADOPTER CATEGORIES CHAPTER 8. DIFFUSION NETWORKS CHAPTER 9. THE CHANGE AGENT CHAPTER 10. INNOVATION IN ORGANIZATIONS CHAPTER 11. CONSEQUENCES OF INNOVATIONS Glossary Bibliography Name Index Subject Index

38,750 citations

Journal ArticleDOI
TL;DR: Upon returning to the U.S., author Singhal’s Google search revealed the following: in January 2001, the impeachment trial against President Estrada was halted by senators who supported him and the government fell without a shot being fired.

23,419 citations


"Informing implementation of quality..." refers methods in this paper

  • ...Several interviewees adopted the language of Rogers’ Diffusion of Innovations theory [14] to describe clinicians and practice teams willingness to change within the APCC program i....

    [...]

Book
01 Jan 1990
TL;DR: In this paper, the Hermeneutic Phenomenology of human science research has been studied in the context of personal experience as a starting point to understand the nature of human experience.
Abstract: Preface Preface to the 2nd Edition 1. Human Science Introduction Why Do Human Science Research? What Is a Hermeneutic Phenomenological Human Science? What Does it Mean to Be Rational? What a Human Science Cannot Do Description or Interpretation? Research-Procedures, Techniques, and Methods Methodical Structure of Human Science Research 2. Turning to the Nature of Lived Experience The Nature of Lived Experience Orienting to the Phenomenon Formulating the Phenomenological Question Explicating Assumptions and Pre-understandings 3. Investigating Experience as We Live It The Nature of Data (datum: thing given or granted) Using Personal Experience as a Starting Point Tracing Etymologjcal Sources Searching Idiomatic Phrases Obtaining Experiential Descriptions from Others Protocol Writing (lived-experience descriptions) Interviewing (the personal life story) Observing (the experiential anecdote) Experiential Descriptions in Literature Biography as a Resource for Experiential Material Diaries, Journals, and Logs as Sources of Lived Experiences Art as a Source of Lived Experience Consulting Phenomenological Literature 4. Hermeneutic Phenomenological Rel1ectlon Conducting Thematic Analysis Situations Seeking Meaning What Is a Theme? The Pedagogy of Theme Uncovering Thematic Aspects Isolating Thematic Statements Composing Linguistic Transformations Gleaning Thematic Descriptions from Artistic Sources Interpretation through Conversation Collaborative Analysis: The Research Seminar/Group Lifeworld Existentials as Guides to Reflection Determining Incidental and Essential Themes 5. Hermeneutic Phenomenological Writing Attending to the Speaking of Language Silence-the Limits and Power of Language Anecdote as a Methodological Device The Value of Anecdotal Narrative Varying the Examples Writing Mediates Reflection and Action To Write is to Measure Our Thoughtfulness Writing Exercises the Ability to See The Write is to Show Something To Write is to Rewrite 6. Maintaining a Strong and Oriented Relation The Relation Between Research/Writing and Pedagogy On the Ineffability of Pedagogy "Seeing" Pedagogy The Pedagogic Practice of Textuality Human Science as Critically Oriented Action Research Action Sensitive Knowledge Leads to Pedagogic Competence 7. Balancing the Research Context by Considering Parts and Whole The Research Proposal Effects and Ethics of Human Science Research Plan and Context of a Research Project Working the Text Glossary Bibliography Index

11,959 citations


"Informing implementation of quality..." refers methods in this paper

  • ...A phenomenological approach [13] was taken to understand participants’ perceptions, perspectives and understanding of the implementation of the APCC program....

    [...]

Journal ArticleDOI
Pippa Hall1
TL;DR: Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.
Abstract: Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.

1,247 citations


"Informing implementation of quality..." refers background in this paper

  • ...a perceived loss of individual GP clinician’s autonomy such as described by Hall in 2009 regarding professional cultures as barriers to interprofessional teamwork [27]....

    [...]

Journal ArticleDOI
TL;DR: EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important and their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.
Abstract: Background Educational outreach visits (EOVs) have been identified as an intervention that may improve the practice of healthcare professionals. This type of face-to-face visit has been referred to as university-based educational detailing, academic detailing, and educational visiting. Objectives To assess the effects of EOVs on health professional practice or patient outcomes. Search methods For this update, we searched the Cochrane EPOC register to March 2007. In the original review, we searched multiple bibliographic databases including MEDLINE and CINAHL. Selection criteria Randomised trials of EOVs that reported an objective measure of professional performance or healthcare outcomes. An EOV was defined as a personal visit by a trained person to healthcare professionals in their own settings. Data collection and analysis Two reviewers independently extracted data and assessed study quality. We used bubble plots and box plots to visually inspect the data. We conducted both quantitative and qualitative analyses. We used meta-regression to examine potential sources of heterogeneity determined a priori. We hypothesised eight factors to explain variation across effect estimates. In our primary visual and statistical analyses, we included only studies with dichotomous outcomes, with baseline data and with low or moderate risk of bias, in which the intervention included an EOV and was compared to no intervention. Main results We included 69 studies involving more than 15,000 health professionals. Twenty-eight studies (34 comparisons) contributed to the calculation of the median and interquartile range for the main comparison. The median adjusted risk difference (RD) in compliance with desired practice was 5.6% (interquartile range 3.0% to 9.0%). The adjusted RDs were highly consistent for prescribing (median 4.8%, interquartile range 3.0% to 6.5% for 17 comparisons), but varied for other types of professional performance (median 6.0%, interquartile range 3.6% to 16.0% for 17 comparisons). Meta-regression was limited by the large number of potential explanatory factors (eight) with only 31 comparisons, and did not provide any compelling explanations for the observed variation in adjusted RDs. There were 18 comparisons with continuous outcomes, with a median adjusted relative improvement of 21% (interquartile range 11% to 41%). There were eight trials (12 comparisons) in which the intervention included an EOV and was compared to another type of intervention, usually audit and feedback. Interventions that included EOVs appeared to be slightly superior to audit and feedback. Only six studies evaluated different types of visits in head-to-head comparisons. When individual visits were compared to group visits (three trials), the results were mixed. Authors' conclusions EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important. Their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.

1,160 citations

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