Process evaluation of a data-driven quality improvement program at Australian primary care practices for improved management of coronary heart disease - a mixed-methods study

Abstract

Quality improvement (QI) strategies are increasingly used in primary care to reduce the burden of coronary heart disease (CHD). This Thesis examines a 12-month QI intervention in a cluster randomised controlled trial, focusing on practice engagement, intervention delivery, and healthcare providers' satisfaction and acceptability, while identifying barriers and enablers in implementing QI interventions in CHD management.

This mixed-methods process evaluation, part of the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with coronary heart disease (QUEL) study, involved 27 Australian primary care practices. The Thesis also includes a systematic review and meta-analysis, offering a comprehensive view of QI interventions in primary care.

An evidence-practice gap was identified in the receipt of subsidised health services and guideline-recommended medications for CHD management, with women more likely to receive these services but less likely to be prescribed antiplatelets compared to men. The systematic review and meta-analysis revealed mixed effectiveness of QI interventions. While they significantly reduced major cardiovascular events and total mortality, no significant improvements were found in the prescription of guideline-recommended medications.

The process evaluation highlighted varied engagement, with 42% of practices attending five or more learning workshops and 69% using Plan-Do-Study-Act cycles. Qualitative data identified learning workshops and monthly feedback reports as key features, while COVID-19 and time constraints were common barriers to engagement. Effective leadership and practice team collaboration emerged as significant enablers.

These findings offer valuable insights for primary care practices aiming to adopt data-driven QI initiatives for CHD management. Further research is needed to evaluate the effectiveness of QI strategies on clinical outcomes in CHD care.