QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with coronary heart disease (QUEL)

A 12 month collaborative quality improvement program via (i) Learning workshops where practices participate in three online (1 hour each) and two face-to-face learning workshops (6 hours each based in Sydney, Australia); (ii) Activity periods where practices use their own electronically extracted data test and implement improvements through cycles of small step-wise changes (implemented strategies within the practice in order to achieve cardiovascular risk factor targets, see below for an example); (iii) Data reporting and feedback where practices submit monthly data and PDSA cycles on which they are provided objective feedback (telephone and in-person visits) on their outcomes and progress and; (iv) Sustainability where Primary Health Networks spread knowledge and success. To spread knowledge and success PHNs will foster a supportive environment where practices share their progress towards achieving goals such that successful strategies can be trialled by other practices and in other areas of health beyond CVD. Training workshops will be standardised across all practices and will provide support and education that support practices to use their practice data to monitor cardiovascular risk factors (cholesterol, blood pressure, smoking status), medication prescription rate, influenza vaccination rates and provision of chronic disease management plans. The mode of training is a combination of short videos, presentations by experts, discussion groups and practical workshops. The two face-to-face workshops will be held at 6 monthly intervals (2 in total) and virtual workshops will be held approximately every four months (3 in total) during the 12 month intervention period. A minimum of two representatives from each practice will attend the learning workshops – ideally this will be one GP and one other practice staff member (ideally a practice nurse or practice manager). The concept being that these staff collaborate with other team members within their practice between workshops. Only personnel who have undergone training in delivery of collaborative quality improvement will deliver the practice support. All practices will have access to an online Sharepoint website for regular communication and support. Practice will be expected to enter detail into sharepoint monthly but engage in practice level improvement on a weekly basis. Intervention fidelity will be monitored by attendance at workshops, engagement with monthly reporting and completion of PDSA cycles and surveys after workshops to examine satisfaction and utility. The step-wise changes will be based on practice setting monthly achievable goals for their practice that supports improve electronic recording and use of data relating to CVD management for patients attending their practice. For example, at baseline a practice will be supported to use their data to see that 70% (for example) of their patients with CHD have a prescription for statin medication and set themselves a goal to increase this to 80% within 3 months. The practice could then implement training of their staff to improve the rate of prescriptions and reassess their performance monthly to monitor their progress towards their goal. The intervention will take place in addition to usual care.