The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial.
OBJECTIVE
To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management.


METHODS
Randomised controlled trial.


METHODS
Twenty-six intervention and 23 control primary care practices in the Netherlands.


METHODS
Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later.


RESULTS
Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant.


CONCLUSIONS
The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument.
Engels
Yvonne
Y
Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, KWAZO 229, 6500 HB Nijmegen, Netherlands. y.engels@anes.umcn.nl
van den Hombergh
Pieter
P
Mokkink
Henk
H
van den Hoogen
Henk
H
van den Bosch
Wil
W
Grol
Richard
R
D005194:Family Practice / Q000458:organization & administration / Q000592:standards; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards