title: Can formal collaborative methodologies improve quality in primary health care in New Zealand? Insights from the EQUIPPED Auckland Collaborative.
abstract: BACKGROUND
  Auckland District Health Board was one of four District Health Boards to trial the Breakthrough Series (BTS) methodology to improve the management of long-term conditions in New Zealand, with support from the Ministry of Health.
  
  
  OBJECTIVE
  To improve clinical outcomes, facilitate planned care and promote quality improvement within participating practices in Auckland.
  
  
  METHODS
  Implementation of the Collaborative followed the improvement model / Institute for Healthcare Improvement methodology. Three topic areas were selected: system redesign, cardio-vascular disease/diabetes, and self-management support. An expert advisory group and the Improvement Foundation Australia helped guide project development and implementation. Primary Health Organisation facilitators were trained in the methodology and 15 practice teams participated in the three learning workshops and action periods over 12 months. An independent evaluation study using both quantitative and qualitative methods was conducted.
  
  
  RESULTS
  Improvements were recorded in cardiovascular disease risk assessment, practice-level systems of care, self-management systems and follow-up and coordination for patients. Qualitative research found improvements in coordination and teamwork, knowledge of practice populations and understanding of managing long-term conditions.
  
  
  CONCLUSIONS
  The Collaborative process delivered some real improvements in the systems of care for people with long-term conditions and a change in culture among participating practices. The findings suggest that by strengthening facilitation processes, improving access to comprehensive population audit tools and lengthening the time frame, the process has the potential to make significant improvements in practice. Other organisations should consider this approach when investigating quality improvement programmes.
authors.affiliation: Auckland District Health Board, New Zealand. ourspace@orcon.net.nz
authors.forename: Celia
authors.initials: C
authors.lastname: Palmer
authors.forename: Janine
authors.initials: J
authors.lastname: Bycroft
authors.forename: Kate
authors.initials: K
authors.lastname: Healey
authors.forename: Adrian
authors.initials: A
authors.lastname: Field
authors.forename: Mazin
authors.initials: M
authors.lastname: Ghafel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003299:Cooperative Behavior; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D055815:Young Adult