Reducing Cardiovascular disease (CVD): Translating an evidence based quality improvement tool into ‘real-world’ general practice

To embed within a Primary Health Network (PHN) a multi-faceted quality improvement intervention for cardiovascular disease (CVD) prevention and to assess its impact on the identification and prevention of CVD risk factors in general practice 1. To improve General Practitioner (GP) identification of CVD risk using absolute risk tools 2. To improve prescribing according to evidence-based practice guidelines 3. To inform dissemination and delivery of strategic support for GP quality improvement activities through local GP organisation 80 General Practices will be recruited for the study from within the Central and Eastern Sydney Primary Health Network (CESPHN). At enrolment each practice will; 1. Access Pen Computer Systems Clinical Audit Tool (Trademark), PrimaryCare TopBar (Trademark) and HealthTracker. The Clinical Audit Tool is a population health reporting tool for General Practice. Its suite of tools provide a population view of the practice data. It allows the practice population to be viewed from the perspective of Preventative care, disease register management, improving data quality, optimising financial opportunities. It is compatible with the leading GP Clinical Desktop Systems in Australian General Practice. Interoperating with the clinical desktop system, the PrimaryCare TopBar can deliver web-based resources directly into patient consultations and provides access to: a. Electronic clinical decision support tools such as HealthTracker (an evidence-based innovative point-of-care electronic decision support tool that improves the identification of patients at high risk of heart disease) b. Cleansing App- Can be used to i)Update Patient’s missing Demographics and Accreditation items while the patient is at consultation; ii)Identify undiagnosed patients who have indicated to have Diabetes, Mental Health, Chronic Kidney Disease or Chronic Obstructive Pulmonary Disease during consultation c. Medicare Benefit Schedule (MBS) App– Quickly identify what MBS items the patient is eligible for. d. Waiting Room App – Provides information to i) Notify Receptionists of missing Patient’s Demographics while the Patient is in the Waiting Room; ii) Identify Patient’s missing Clinical/Accreditation items prior to consultation. Each practice will be provided with 30minutes of training and ongoing support by the Primary Care Network (PHN) Project Officer (PO), in the use of this suite of tools for all administrative and clinical staff. The GP’s will be specifically trained in the use of HealthTracker. 2. Provide a baseline report of the Practice profile using the Clinical Audit Tool and then 5 monthly dataset downloads (identification of patients with high risk of CVD; prescribing of recommended medications: aspirin, statins and ACE to high risk patients; regular measurement of clinical BP, weight, waist, LDL cholesterol, HDL cholesterol, ACR in high risk patients) prior to the commencement of the actual intervention. 3. Complete a Clinical Microsystem Analysis tool. This tool will be used for qualitative analysis of the clinical microsystem features of General Practices that assists them in adopting Quality Improvement recommendations and achieving sustainable change.(Johnson & Barach, 2008) 4. Attend a One day face to face Workshop where the Quality Improvement Collaboration (QIC) model and the specific aims and data targets of this project will be introduced by expert and peer presenters. The QIC methodology utilises a series of learning workshops where the General Practice participants exchange ideas, share experiences and learn from experts about the topic for Improvement. There are 5 essential change principles for the topic: 1) Build a Practice Team, 2) Establish a system for updating a register of people with the disease or condition (such as CVD), 3) Be systematic and proactive in managing care, 4) Involve patients in delivering and developing care, 5) Develop effective links with key local partners. Participants learn how to make and test changes using the “Model for Improvement” that consists of 3 Fundamental questions- a) What are we trying to accomplish? (Goal), b) How will we know that a change is an improvement? (Measure), c) What Changes can we make that will result in an improvement? (Idea). The Practice team then use PDSA (Plan, Do, Study, Act) cycles arising from the “Idea” until the “Goal” has been achieved. The participants will be acquainted with how to make use of PDSA’s to assist the GPs in achieving improvements based on their data results. 5. Receive ongoing support from the PHN PO in the use of PrimaryCareTopBar, Clinical Audit Tool and HealthTracker to assist change of practice. Monthly administrative support and reminders to download the data and submit one PDSA (Plan, Do, Study, Act) statement that documents the “idea” which has been addressed each month. 6. Obtain individualised monthly graphical feedback and a de-identified overall summary for the entire cohort. 7. Be offered membership in a local “GP QI Network”. Practices will be encouraged to share their solutions as well as the difficulties encountered via weekly group email discussion forums, bimonthly webinars (45 minutes at lunchtime or evenings) and/ or 3 monthly face to face meetings (1 hour breakfast meetings in locally accessible locations). This GP QI Network will act as both a method of collaboration and joint problem solving. The GP QI Network will be coordinated and facilitated by the PHN PO. Webinars and face to face meetings will be scheduled to occur over the first 12 months of the project. It is anticipated that the PHN will then continue to support the network after this time if the GP QI Network has achieved a regular membership of participating practices. The active QI intervention will last 6 months.