Future Health Today: A cluster randomised controlled trial of quality improvement activities in general practice

Future Health Today (FHT) trial is testing a quality improvement (QI) program in order to reduce cardiovascular disease (CVD) risk in people with chronic kidney disease (CKD) and to facilitate earlier diagnosis of cancer in general practice. The intervention consists of: 1. Technology platform consisting of audit, point of care clinical decision support, and QI templates. Practices will generate a baseline cohort of patients using the audit tool at the beginning of the trial. The progress of the cohort will be automatically updated using the Future Health Today platform over the trial duration. Practices will be encouraged to review their progress and complete a minimum of three reviews of audit data as part of an accredited Royal Australian College of General Practitioners (RACGP) quality improvement activity. These can be carried out at any time during the trial, but we will recommend that they are conducted at least once every four months over the 12-month trial period. The point of care tool will automatically deploy when the electronic medical record of an eligible patient is opened and will provide a prompt regarding guideline-concordant care. The QI template has been developed specifically for this study, and aligns to RACGP requirements. 2. ECHO (Extension for Community Healthcare Outcomes) education activities. ECHO sessions are delivered using the zoom videoconference platform. The 60-minute sessions consist of (1) Introductions of participants (2) Delivery of a short didactic lecture (approximately 10 minutes in duration), followed by question and answer session (3) Presentation of a clinical case by a participant followed by feedback from participants and an expert panel. Each arm will receive 3 ECHO sessions based on their allocation (see below). The ECHO activities will be facilitated and presented by GPs and relevant disease specialists e.g. nephrologists, urologists, oncologists, gastroenterologists etc.) depending on trial arm. These activities will be offered in month 1, 3 and 6. Both arms will be invited to three QI sessions. The QI sessions will include topics on RACGP requirements for QI activities, building a team to lead QI and QI frameworks; these will be tailored based on participant requirements consistent with the ECHO model. These sessions will be held in months 2, 7 and 10. 3. QI toolkit, phone and zoom support to develop practice-specific QI programs will be provided by practice liaison staff who have been trained in QI methodology at the University of Melbourne. Support offered to practices will vary depending on the practice-specific needs identified through communication between practice champions and practice liaison staff at the University of Melbourne (both prompted by practice liaison staff and as requested by the practice). Practices will be able to request additional QI support from Primary Health Networks. The QI toolkit consists of an introduction to QI, a framework that can be used for QI activities and links to web-based resources that can assist practices with QI activities. Arm 1: Arm 1 will have access to the chronic kidney disease (CKD) FHT module. The focus will be on increasing appropriate use of Angiotensin Converting Enzyme inhibitor or angiotensin receptor blocker and/or statin medications which are known to slow the progression of CKD and reduce cardiovascular disease (CVD) risk respectively in people with CKD. General practices in Arm 1 will be offered three ECHOs on chronic kidney disease (Cardiovascular risk assessment, controversies in cardiovascular disease management in people with chronic kidney disease, management of hypertension in people with chronic kidney disease; these will be tailored based on participant requirements consistent with the ECHO model) and three on quality improvement. Arm 2: Arm 2 will have access to the cancer FHT module. The focus will be on identifying people at risk of undiagnosed cancer based on abnormal pathology results, and recalling them for appropriate assessment and investigation. General practices in Arm 2 will be offered three ECHOs on identification and management of people at increased risk of undiagnosed cancer (prostate cancer screening, high platelet count and cancer, anaemia and cancer; these will be tailored based on participant requirements consistent with the ECHO model), and three on quality improvement. A process evaluation will be conducted. Participation in ECHO activities, usage of FHT platform, interaction with practice participants will be recorded. QI templates which summarise the activities undertaken by practices will be collected. Brief surveys after each ECHO module will be completed.