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Epidemiology/Health Services Research
Impact of a primary healthcare quality improvement program on diabetes in Canada: evaluation of the Quality Improvement and Innovation Partnership (QIIP)
  1. Sonja M Reichert1,
  2. Stewart B Harris1,
  3. Jordan W Tompkins1,
  4. Judith Belle-Brown1,
  5. Meghan Fournie1,
  6. Michael Green2,
  7. Han Han2,
  8. Jyoti Kotecha2,
  9. Selam Mequanint1,
  10. Jann Paquette-Warren1,
  11. Sharon Roberts3,
  12. Grant Russell4,
  13. Moira Stewart1,
  14. Amardeep Thind1,
  15. Susan Webster-Bogaert1,
  16. Richard Birtwhistle2
  1. 1 Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
  2. 2 Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen’s University, Kingston, Canada
  3. 3 Renison University College, Waterloo, Canada
  4. 4 Southern Health and Monash University, Notting Hill, Victoria, Australia
  1. Correspondence to Dr Sonja M Reichert; sonja.reichert{at}schulich.uwo.ca

Abstract

Objective Primary healthcare (PHC) quality improvement (QI) initiatives are designed to improve patient care and health outcomes. We evaluated the Quality Improvement and Innovation Partnership (QIIP), an Ontario-wide PHC QI program on access to care, diabetes management and colorectal cancer screening. This manuscript highlights the impact of QIIP on diabetes outcomes and associated vascular risk factors.

Research design and methods A cluster matched-control, retrospective prechart and postchart audit was conducted. One physician per QIIP-PHC team (N=34) and control (N=34) were recruited for the audit. Eligible charts were reviewed for prespecified type 2 diabetes mellitus clinical process and outcome data at baseline, during (intervention range: 15–17.5 months) and post. Primary outcome measures were the A1c of patients above study target and proportion of patients with an annual foot exam. Secondary outcome measures included glycemic, hypertension and lipid outcomes and management, screening for diabetes-related complications, healthcare utilization, and diabetes counseling, education and self-management goal setting.

Results More patients in the QIIP group achieved statistically improved lipid testing, eye examinations, peripheral neuropathy exams, and documented body mass index. No statistical differences in A1c, low-density lipoprotein or systolic/diastolic blood pressure values were noted, with no significant differences in medication prescription, specialist referrals, or chart-reported diabetes counseling, education or self-management goals. Patients of QIIP physicians had significantly more PHC visits.

Conclusion The QIIP-learning collaborative program evaluation using stratified random selection of participants and the inclusion of a control group makes this one of the most rigorous and promising efforts to date evaluating the impact of a QI program in PHC. The chart audit component of this evaluation highlighted that while QIIP improved some secondary diabetes measures, no improvements in clinical outcomes were noted. This study highlights the importance of formalized evaluation of QI initiatives to provide an evidence base to inform future program planning and scale-up.

  • diabetes
  • evidence-based medicine
  • primary healthcare
  • health policy
  • quality improvement
  • program evaluation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2017-000392

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    Footnotes

    • Contributors SBH, MG, RB, JBB, GR, SW-B, JP-W, AT, SR, JK and MS contributed to the conception and design of the study. SW-B, MF, SBH, RB, JK, HH, GR, AT, MS and MG researched the diabetes chart audit data. SBH, SW-B, MF, SM, MG, and AT analysed the data. SBH, RB, MG, SW-B, MF, SM, SR and JWT interpreted the data. SR and JWT drafted the manuscript. All authors contributed to intellectual discussion and reviewed and edited the manuscript. SBH and SR are the guarantors of this study.

    • Funding Funding for this evaluation was provided through a contract agreement between Health Quality Ontario and Western/Queen’s University.

    • Competing interests None declared.

    • Patient consent A waiver of patient consent for the chart audit was granted under the Ontario Personal Health Information Protection Act (PHIPA) from the Ethics Review Board at Western University London Ontario Canada and Queen's University, Kingston Ontario, Canada.

    • Ethics approval Ethics approval for the evaluation was obtained from Western University and Queen’s University. A waiver of patient consent for the chart audit was granted under the Ontario Personal Health Information Protection Act (PHIPA) from each Ethics Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.