Practice-level quality improvement interventions in primary care: a review of systematic reviews

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Practice-level quality improvement interventions in primary care : a review of systematic reviews. / Irwin, Ryan; Marshall, Tom; Stokes, Timothy.

In: Primary Health Care Research & Development, Vol. 16, No. 6, 11.2015, p. 556-577.

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@article{578112ff3ed64574a70b5cd39e876bb4,
title = "Practice-level quality improvement interventions in primary care: a review of systematic reviews",
abstract = "Aim: To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews.Background Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care – the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting.Methods Design: A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Scope: Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. Outcome measures: A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions.Findings Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions.Conclusion Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.",
keywords = "primary care, quality improvement, systematic review ",
author = "Ryan Irwin and Tom Marshall and Timothy Stokes",
year = "2015",
month = nov,
doi = "10.1017/S1463423615000274",
language = "English",
volume = "16",
pages = "556--577",
journal = "Primary Health Care Research & Development",
issn = "1463-4236",
publisher = "Cambridge University Press",
number = "6",

}

RIS

TY - JOUR

T1 - Practice-level quality improvement interventions in primary care

T2 - a review of systematic reviews

AU - Irwin, Ryan

AU - Marshall, Tom

AU - Stokes, Timothy

PY - 2015/11

Y1 - 2015/11

N2 - Aim: To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews.Background Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care – the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting.Methods Design: A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Scope: Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. Outcome measures: A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions.Findings Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions.Conclusion Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.

AB - Aim: To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews.Background Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care – the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting.Methods Design: A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Scope: Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. Outcome measures: A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions.Findings Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions.Conclusion Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.

KW - primary care

KW - quality improvement

KW - systematic review

U2 - 10.1017/S1463423615000274

DO - 10.1017/S1463423615000274

M3 - Article

VL - 16

SP - 556

EP - 577

JO - Primary Health Care Research & Development

JF - Primary Health Care Research & Development

SN - 1463-4236

IS - 6

ER -