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RESEARCH ARTICLE (Open Access)
Contents Vol 31(1)

Implementation of a data-driven quality improvement program in primary care for patients with coronary heart disease: a mixed methods evaluation of acceptability, satisfaction, barriers and enablers

Nashid Hafiz A * , Karice Hyun A B , Qiang Tu A , Andrew Knight C D , Clara K. Chow F G , Charlotte Hespe https://orcid.org/0000-0002-4582-7728 E , Tom Briffa H , Robyn Gallagher I , Christopher M. Reid J K , David L. Hare L , Nicholas Zwar M , Mark Woodward N O , Stephen Jan N , Emily R. Atkins N , Tracey-Lea Laba P , Elizabeth Halcomb https://orcid.org/0000-0001-8099-986X Q , Tracey Johnson R , Deborah Manandi https://orcid.org/0000-0002-7532-0477 A , Tim Usherwood N and Julie Redfern A N
+ Author Affiliations
- Author Affiliations

A School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.

B Department of Cardiology, Concord Hospital, ANZAC Research Institute, Concord, NSW, Australia.

C Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, NSW, Australia.

D School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia.

E The University of Notre Dame, School of Medicine, Sydney, NSW, Australia.

F Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia.

G Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, Westmead, NSW, Australia.

H School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia.

I Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.

J School of Population Health, Curtin University, Bentley, WA, Australia.

K School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.

L The University of Melbourne and Austin Health, Melbourne, Vic., Australia.

M Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia.

N The George Institute for Global Health, University of New South Wales, Barangaroo, NSW, Australia.

O The George Institute for Global Health, School of Public Health, Imperial College London,Oxford, Oxfordshire, UK.

P Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.

Q School of Nursing, University of Wollongong, Wollongong, NSW, Australia.

R Inala Primary Care, Inala, Qld, Australia.

* Correspondence to: nashid.hafiz@sydney.edu.au

Australian Journal of Primary Health 31, PY24034 https://doi.org/10.1071/PY24034
Submitted: 21 March 2024  Accepted: 17 December 2024  Published: 14 January 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

The study aimed to understand the acceptability, satisfaction, uptake, utility and feasibility of a quality improvement (QI) intervention to improve care for coronary heart disease (CHD) patients in Australian primary care practices and identify barriers and enablers, including the impact of COVID-19.

Methods

Within the QUality improvement for Effectiveness of care for people Living with heart disease (QUEL) study, 26 Australian primary care practices, supported by five Primary Health Networks (PHN) participated in a 1-year QI intervention (November 2019 – November 2020). Data were collected from practices and PHNs staff via surveys and semi-structured interviews. Quantitative and qualitative data were analysed with descriptive statistics and thematic analysis, respectively.

Results

Feedback was received from 64 participants, including practice team members and PHN staff. Surveys were completed after each of six workshops and at the end of the study. Interviews were conducted with a subgroup of participants (n = 9). Participants reported positive satisfaction with individual QI features such as learning workshops and monthly feedback reports. Overall, the intervention was well-received, with most participants expressing interest in participating in similar programs in the future. COVID-19 and lack of time were identified as common barriers, whereas team collaboration and effective leadership enabled practices’ participation in the QI program. Additionally, 90% of the practices reported COVID-19 effected their participation due to vaccination rollout, telehealth set-up, and continuous operational review shifting their focus from QI.

Conclusion

Data-driven QI programs in primary care can boost practice staff confidence and foster increased implementation. Barriers and enablers identified can also support other practices in prioritising effective strategies for future implementation.

Keywords: coronary heart disease, COVID-19, data, mixed methods research, primary care, process evaluation, qualitative research, quality improvement.

References

Alkhenizan A, Shaw C (2011) Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi Medicine 31, 407-416.
| Crossref | Google Scholar | PubMed |

Australian Institute of Health Welfare (2023) Heart, stroke and vascular disease: Australian facts. AIHW, Canberra. Available at https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/hsvd-facts.

Bailie R, Bailie J, Chakraborty A, Swift K (2015) Consistency of denominator data in electronic health records in Australian primary healthcare services: enhancing data quality. Australian Journal of Primary Health 21(4), 450-459.
| Crossref | Google Scholar | PubMed |

Batalden PB, Davidoff F (2007) What is “quality improvement” and how can it transform healthcare? Quality and Safety in Health Care 16(1), 2-3.
| Crossref | Google Scholar | PubMed |

Bravata D, Myers LJ, Homoya B, Miech EJ, Rattray NA, Perkins AJ, Zhang Y, Ferguson J, Myers J, Cheatham AJ, Murphy L, Giacherio B, Kumar M, Cheng E, Levine DA, Sico JJ, Ward MJ, Damush TM (2019) The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods. BMC Neurology 19, 294.
| Crossref | Google Scholar |

Chalasani S, Peiris DP, Usherwood T, Redfern J, Neal BC, Sullivan DR, Colagiuri S, Zwar NA, Li Q, Patel A (2017) Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative. Medical Journal of Australia 206(10), 436-441.
| Crossref | Google Scholar | PubMed |

Dale CE, Takhar R, Carragher R, Katsoulis M, Torabi F, Duffield S, Kent S, Mueller T, Kurdi A, Le Anh TN, McTaggart S, Abbasizanjani H, Hollings S, Scourfield A, Lyons RA, Griffiths R, Lyons J, Davies G, Harris D, Handy A, Mizani MA, Tomlinson C, Thygesen JH, Ashworth M, Denaxas S, Banerjee A, Sterne JAC, Brown P, Bullard I, Priedon R, Mamas MA, Slee A, Lorgelly P, Pirmohamed M, Khunti K, Morris AD, Sudlow C, Akbari A, Bennie M, Sattar N, Sofat R, CVD-COVID-UK Consortium (2023) The impact of the COVID-19 pandemic on cardiovascular disease prevention and management. Nature Medicine 29, 219-225.
| Crossref | Google Scholar | PubMed |

Damush TM, Penney LS, Miech EJ, Rattray NA, Baird SA, Cheatham AJ, Austin C, Sexson A, Myers LJ, Bravata DM (2021) Acceptability of a complex team-based quality improvement intervention for transient ischemic attack: a mixed-methods study. BMC Health Services Research 21, 453.
| Crossref | Google Scholar |

Dawadi S (2020) Thematic analysis approach: a step by step guide for ELT research practitioners. Journal of NELTA 25(1–2), 62-71.
| Crossref | Google Scholar |

Einarsdóttir K, Preen DB, Emery JD, Holman CDAJ (2011) Regular primary care plays a significant role in secondary prevention of ischemic heart disease in a Western Australian cohort. Journal of General Internal Medicine 26, 1092-1097.
| Crossref | Google Scholar | PubMed |

Hafiz N, Hyun K, Tu Q, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba T-L, Halcomb E, Johnson T, Usherwood T, Redfern J (2022) Data-driven quality improvement program to prevent hospitalisation and improve care of people living with coronary heart disease: Protocol for a process evaluation. Contemporary Clinical Trials 118, 106794.
| Crossref | Google Scholar | PubMed |

Harvey G, Lynch E (2017) Enabling continuous quality improvement in practice: the role and contribution of facilitation. Frontiers in Public Health 5, 27.
| Crossref | Google Scholar | PubMed |

Hespe CM, Giskes K, Harris MF, Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation. BMC Health Services Research 22, 108.
| Crossref | Google Scholar | PubMed |

Hodgkins A, Mullan J, Mayne D, Boyages C, Bonney A (2020) Australian general practitioners’ attitudes to the extraction of research data from electronic health records. Australian Journal of General Practice 49(3), 145-150.
| Crossref | Google Scholar |

Hunter SB, Rutter CM, Ober AJ, Booth MS (2017) Building capacity for continuous quality improvement (CQI): A pilot study. Journal of Substance Abuse Treatment 81, 44-52.
| Crossref | Google Scholar | PubMed |

Knight AW, Dhillon M, Smith C, Johnson J (2019) A quality improvement collaborative to build improvement capacity in regional primary care support organisations. BMJ Open Quality 8(3), e000684.
| Crossref | Google Scholar | PubMed |

McNicholas C, Lennox L, Woodcock T, Bell D, Reed JE (2019) Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. BMJ Quality & Safety 28(5), 356-365.
| Crossref | Google Scholar | PubMed |

Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J (2015) Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350, h1258.
| Crossref | Google Scholar | PubMed |

Naeem M, Ozuem W, Howell K, Ranfagni S (2023) A step-by-step process of thematic analysis to develop a conceptual model in qualitative research. International Journal of Qualitative Methods 22, 16094069231205789.
| Crossref | Google Scholar |

Patel B, Peiris D, Usherwood T, Li Q, Harris M, Panaretto K, Zwar N, Patel A (2017) Impact of sustained use of a multifaceted computerized quality improvement intervention for cardiovascular disease management in Australian primary health care. Journal of the American Heart Association 6(10), e007093.
| Crossref | Google Scholar | PubMed |

Redfern J, Hafiz N, Hyun K, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid C, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba T-L, Halcomb E, Billot L, Johnson T, Usherwood T (2020) QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people living with coronary heart disease (QUEL): protocol for a 24-month cluster randomised controlled trial in primary care. BMC Family Practice 21, 36.
| Crossref | Google Scholar |

Schierhout G, Hains J, Si D, Kennedy C, Cox R, Kwedza R, O’Donoghue L, Fittock M, Brands J, Lonergan K, Dowden M, Bailie R (2013) Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change. Implementation Science 8, 119.
| Crossref | Google Scholar | PubMed |

Sibthorpe B, Gardner K, Chan M, Dowden M, Sargent G, McAullay D (2018) Impacts of continuous quality improvement in Aboriginal and Torres Strait Islander primary health care in Australia. Journal of Health Organization and Management 32(4), 545-571.
| Crossref | Google Scholar |

Wikström K, Toivakka M, Rautiainen P, Tirkkonen H, Repo T, Laatikainen T (2019) Electronic health records as valuable data sources in the health care quality improvement process. Health Services Research and Managerial Epidemiology 6, 2333392819852879.
| Crossref | Google Scholar | PubMed |

Zhou S, Ma J, Dong X, Li N, Duan Y, Wang Z, Gao L, Han L, Tu S, Liang Z, Liu F, LaBresh KA, Smith SC, Jr, Jin Y, Zheng Z-J (2022) Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research. Implementation Science 17, 36.
| Crossref | Google Scholar | PubMed |