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Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation

Pam Moule¹, Susan Clompus¹, Jon Fieldhouse¹

¹Faculty of Health and Applied Sciences, UWE, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS16 1DD, UK.

Journal of Evaluation in Clinical Practice

|May 26, 2018

Summary

Implementing quality improvement programs in General Practice can reduce stroke risk in atrial fibrillation patients. Success depends on addressing local workload and practitioner experience, ensuring lasting improvements in care.

Keywords:

atrial fibrillation case studies general practice pharmacists quality improvement realist evaluation

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Area of Science:

General Practice
Public Health
Health Services Research

Background:

Underuse of anticoagulants in atrial fibrillation increases stroke risk.
National Institute for Health Care and Excellence guidance CG180 aims to reduce strokes via Non-vitamin K antagonist Oral Anticoagulants.
A quality improvement programme was implemented in General Practice to align with CG180.

Purpose of the Study:

To evaluate the effectiveness of a quality improvement programme in implementing NICE guidance.
To understand the contextual factors influencing the programme's success.
To determine how and under what circumstances the programme achieved its objectives.

Main Methods:

Realist evaluation of a quality improvement programme across six General Practices.
Data collection included recordings of team meetings and interviews with practice leads.
Analysis involved comparing observational and interview data against the initial programme theory.

Main Results:

Varied use of quality improvement resources, with training highly valued.
Programme theories were refined, acknowledging local workload and practitioner beliefs.
Optimal outcomes and lasting legacy were achieved when key motivators like prior experience were present.

Conclusions:

Quality improvement programmes can drive practice change and create lasting improvements.
Successful implementation requires specific mechanisms and a commitment to service improvement.
Contextual factors, including practitioner experience and workload, significantly influence outcomes.