Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices

Area of Science:

• Primary Care Medicine
• Quality Improvement Science

Background:

• Smaller primary care practices often face challenges in implementing quality improvement initiatives.
• Building internal capacity for quality improvement is crucial for enhancing clinical performance.

Purpose of the Study:

• To assess the impact of implementing 7 evidence-based strategies on quality improvement capacity in small primary care practices.
• To determine the association between enhanced quality improvement capacity and performance on cardiovascular disease clinical quality measures (CQMs).

Main Methods:

• A pragmatic clinical trial involving 209 practices in Washington, Oregon, and Idaho.
• Quality improvement capacity was measured using the 12-point Quality Improvement Capacity Assessment (QICA) questionnaire.
• Performance on 3 cardiovascular CQMs (aspirin use, BP control, smoking screening/cessation) was assessed at baseline (2015) and follow-up (2017) using regression analyses.

Main Results:

• Practices showed a significant improvement in QICA scores (1.44 points, P <.001).
• All 3 cardiovascular CQMs improved: aspirin use (3.98%), BP control (3.36%), and tobacco screening/cessation (7.49%).
• Each 1-point increase in QICA score correlated with a 1.25% improvement in BP control (P = .003).

Conclusions:

• Implementation of 7 evidence-based strategies effectively improved quality improvement capacity in small primary care practices.
• These strategies are feasible and associated with enhanced clinical performance in cardiovascular care.
• Quality improvement capacity building is a viable approach to improving patient outcomes in primary care settings.