Clinical and organization impacts in primary care clinic and home based primary care through quality improvement in a...

The VA Geriatric Scholars Program is a continuing professional development (CPD) program for interprofessional primary care clinicians to enhance skills in the care of older adults. Following intensive didactic education, participants select and initiate local quality improvement (QI) projects. This evaluation examines the types and range of variation among learner-selected QI. Using a qualitative thematic analysis with a constant comparison approach, we characterized variation among 813 QI project reports from a variety of clinical care settings, resulting in a multi-level schema of 3 themes, 13 subthemes, and 79 foci. Using this typology, we then compared a subsample of projects in general primary care (n = 401) and home based primary care (n = 330). Overall, 72.8% of these QI directly impacted clinical care in identifying and managing health conditions by clinicians or through patient education. The remaining projects addressed organizational barriers to clinic efficiencies. These practical, successful QI strategies might be diffused more broadly, perhaps through implementation science research, policy proposals, or as exemplars for other clinical training programs or locally initiated projects, such as Age Friendly Action Communities.