Continuous Quality Improvement Cohorts on Advanced Access

Primary Health Care Clinical Trial

Official title:

Impact of Externally Facilitated Continuous Quality Improvement Cohorts on Advanced Access to Support Primary Healthcare Teams

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05715151
• Other study ID #: MP-04-2022-696
• Status: Recruiting
• Phase: N/A
• Start date: September 21, 2022
• Est. completion date: June 1, 2025

Study information

• Verified date: February 2023
• Source: Université de Sherbrooke
• Contact: Elisabeth Martin, Ph.D(c)
• Phone: 5147799926
• Email: elisabeth.martin[@]usherbrooke.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this clinical trial is to compare the implementation and effects of CQI cohorts on AA for PHC clinics. The main questions it aims to answer are to assess the effectiveness of CQI cohorts on AA outcomes.

Description:

SIGNIFICANCE AND PURPOSE: Timely access to primary healthcare is one cornerstone of strong primary healthcare. Across Canada, timely access remains a significant challenge. One of the most highly recommended models around the world to improve timely access is advanced access (AA). Over the last two decades, AA has become increasingly popular in Canada. AA model has been widely promoted by the College of Family Physicians of Canada and several other provincial organizations and professional associations. Some tools to support the implementation of AA to PHC providers and practices have been developed such as workbook by Health Quality Ontario and Doctor of BC. However, those tools are important assets to initiate a reflection to improve, they are often not sufficient. Eight PHC teams interested in improving and expanding the implementation of AA have been coached through several PDSA cycles. However, the personalized support model used is very demanding in terms of capacity and resources. These findings guided the research team in developing and evaluating a Continuous Quality Improvement (CQI) Cohort program on advanced access to support Primary healthcare (PHC) teams.This study aims to develop knowledge on an externally facilitated CQI pan-Canadian cohort program that could potentially be transferred to provincial organizations or professional associations wishing to support clinics in quality improvement projects.

OBJECTIVE: Assess the effectiveness of CQI cohorts on AA outcomes.

QI INTERVENTION PROGRAM: PHC teams will participate in an externally facilitated CQI program focusing on AA. The proposed program consists of cycle of three key activities; 1) Interprofessional reflective sessions and need prioritization, 2) Group mentoring and PDSA Cycles and 3) Cohort cross-learning exchange opportunities.

METHODS: This study will be based on the cluster-controlled trial of a CQI program of PHC teams on AA. 48 PHC teams from Quebec will participate to the externally facilitated CQI cohort intervention. Volunteer clinics from the intervention regions will receive the CQI intervention for 18 months. Intervention clinics will be matched to PHC clinics located in other regions to compose the control group. The match will be based on the clinic level (1 to 10, based on the number of patients registered and services offered. Clinics in the control group will receive an audit on a selection of AA indicators and will be offered the intervention 12 to 18 months following their recruitment. Data collection and analysis will include quantitative data based on a comprehensive assessment of both AA processes and outcomes. These will be measured through a self-reflective survey for PHC team members, EMR data and patients related outcomes questionnaire on access. Qualitative data based on semi-structured interviews with key stakeholders, observations of the CQI activities and analysis of plans of action of documents plan of action will take place.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 48
• Est. completion date: June 1, 2025
• Est. primary completion date: June 1, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion criteria:

• Clinics must offer interprofessional care.

• At least 50 % of all team members should accept to take part in the study.

Exclusion criteria:

• Solo Practice Physicians

• Physician-nurse only model

Related Conditions & MeSH terms

• Primary Health Care

Intervention

Other:
• CQI intervention
Activity 1: Reflective sessions and problem prioritisation. Activity 2: PDSA cycles. Activity 3: Group mentoring.
• Audit and Feedback
Audit and Feedback on six key AA indicators, patients reported experience about access and selected AA processes.

Locations

Country	Name	City	State
Canada	CISSS de la Gaspésie	Gaspé	Quebec
Canada	CISSS de l'Outaouais	Gatineau	Quebec
Canada	CISSS de Lanaudière	Joliette	Quebec
Canada	CISSS de Laval	Laval	Quebec
Canada	CISSS de Chaudière-Appalaches	Lévis	Quebec
Canada	CIUSSS de Montérégie-Centre	Longueuil	Quebec
Canada	CIUSSS de l'Est-de-l'Île-de-Montréal	Montréal	Quebec
Canada	CIUSSS de l'Ouest-de-l'Île-de-Montréal	Montréal	Quebec
Canada	CIUSSS du Centre-Ouest-de-l'Île-de-Montréal	Montréal	Quebec
Canada	CIUSSS du Centre-Sud-de-l'Île-de-Montréal	Montréal	Quebec
Canada	CIUSSS du Nord-de-l'Île-de-Montréal	Montréal	Quebec
Canada	CIUSSS de la Capitale-Nationale	Québec
Canada	CISSS de l'Abitibi-Témiscamingue	Rouyn-Noranda	Quebec
Canada	CISSS de la Montérégie-Ouest	Saint-Hubert	Quebec
Canada	CISSS de la Montérégie-Est	Saint-Hyacinthe	Quebec
Canada	CISSS des Laurentides	Saint-Jérôme	Quebec
Canada	CIUSSS de l'Estrie-CHUS	Sherbrooke	Quebec
Canada	CIUSSS de la Mauricie et Centre-du-Québec	Trois-Rivières	Quebec

Sponsors (6)

Lead Sponsor	Collaborator
Université de Sherbrooke	Isabelle Gaboury, Janusz Kaczorowski, Maude Laberge, Mike Green, Tara Kiran

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	3rd next available appointment (weekly)	Delay before the 3rd next available appointment. The 3rd next available appointment is used (rather than the 1st or 2nd) to decrease variation.	18 month
Primary	Percent of relational continuity (monthly)	Total number of medical consultations with a patient's attached family physician (or specialised nurse) out of the total number of consultations with any family physician (or specialised nurse) from the clinic. Evaluates relational continuity between the provider and their registered patients.	18 month
Secondary	Percent of 48-hour open slots (weekly)	Proportion of appointments available in the next 48 hours. Provides an overview of the provider's ability to respond to urgent care demands.	18 month
Secondary	Use of walk-in (monthly)	Proportion of walk-in visits by registered patients to each professional.	18 month
Secondary	Proportion of multidisciplinary involvement (monthly)	Evaluates the proportion of involvement of different types of providers (social workers, nurses, pharmacists, etc.) with registered patients.	18 month
Secondary	Discontinuity for chronic patients (monthly)	Proportion of chronic patients without any consultations within the last 12 months.	18 month
Secondary	3rd next available appointment (weekly)	Delay before the 3rd next available appointment. The 3rd next available appointment is used (rather than the 1st or 2nd) to decrease variation.	12 month
Secondary	Percent of relational continuity (monthly)	Total number of medical consultations with a patient's attached family physician (or specialised nurse) out of the total number of consultations with any family physician (or specialised nurse) from the clinic. Evaluates relational continuity between the provider and their registered patients.	12 month