title: Impact of a quality improvement program on primary healthcare in Canada: a mixed-method evaluation.
abstract: OBJECTIVE
  Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement and Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning.
  
  
  METHODS
  This article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: (1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; (2) post-only advanced access survey (third-next available appointment); and (3) post-only semi-structured interviews (team functioning).
  
  
  RESULTS
  Chart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p=0.10]; foot exams [p=0.45]; CRC screening [p=0.77]; advanced access [p=0.22]). Qualitative interview (n=42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity.
  
  
  CONCLUSIONS
  The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: stewart.harris@schulich.uwo.ca.
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
authors.affiliation: Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: michael.green@dfm.queensu.ca.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Green
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: judith.brown@schulich.uwo.ca.
authors.forename: Judith Belle
authors.initials: JB
authors.lastname: Brown
authors.affiliation: Renison University College at the University of Waterloo, 240 Westmount Road North, Waterloo, Ontario Canada N2L 3G4. Electronic address: serobert@uwaterloo.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill VIC, 3168, Australia. Electronic address: grant.russell@med.monash.edu.au.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: meghan.fournie@schulich.uwo.ca.
authors.forename: Meghan
authors.initials: M
authors.lastname: Fournie
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: susan.webster-bogaert@schulich.uwo.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Webster-Bogaert
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: jann.paquette-warren@schulich.uwo.ca.
authors.forename: Jann
authors.initials: J
authors.lastname: Paquette-Warren
authors.affiliation: Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: jyoti.kotecha@cspc.queensu.ca.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Kotecha
authors.affiliation: Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: han.han@cspc.queensu.ca.
authors.forename: Han
authors.initials: H
authors.lastname: Han
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, Room K201, London, Ontario, Canada. Electronic address: amardeep.thind@schulich.uwo.ca.
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: moira.stewart@schulich.uwo.ca.
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: sonja.reichert@schulich.uwo.ca.
authors.forename: Sonja
authors.initials: S
authors.lastname: Reichert
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1151 Richmond Street, London, Ontario Canada N6A 3K7. Electronic address: jordan.tompkins@schulich.uwo.ca.
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Tompkins
authors.affiliation: Centre for Studies in Primary Care, Department of Family Medicine, School of Medicine, Queen's University. 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario Canada K7L 5E9. Electronic address: richard.birtwhistle@dfm.queensu.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: Birtwhistle
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003299:Cooperative Behavior; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies
keywords: Advanced access; Colorectal cancer screening; Diabetes; Evaluation; Interdisciplinary teams; Primary healthcare; Quality improvement