Clinical trial NCT05715151: Continuous Quality Improvement Cohorts on Advanced Access
Official title: Impact of Externally Facilitated Continuous Quality Improvement Cohorts on Advanced Access to Support Primary Healthcare Teams
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Primary Health Care
Keywords: Advanced Access
Primary Health Care
Quality improvement
Lead sponsor: Université de Sherbrooke
Sponsor class: OTHER
Collaborators: name: Isabelle Gaboury
name: Mike Green
name: Tara Kiran
name: Janusz Kaczorowski
name: Maude Laberge
First posted: 2023-02-06
Enrollment: 48
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The goal of this clinical trial is to compare the implementation and effects of CQI cohorts on AA for PHC clinics. The main questions it aims to answer are to assess the effectiveness of CQI cohorts on AA outcomes.

Detailed description: SIGNIFICANCE AND PURPOSE: Timely access to primary healthcare is one cornerstone of strong primary healthcare. Across Canada, timely access remains a significant challenge. One of the most highly recommended models around the world to improve timely access is advanced access (AA). Over the last two decades, AA has become increasingly popular in Canada. AA model has been widely promoted by the College of Family Physicians of Canada and several other provincial organizations and professional associations. Some tools to support the implementation of AA to PHC providers and practices have been developed such as workbook by Health Quality Ontario and Doctor of BC. However, those tools are important assets to initiate a reflection to improve, they are often not sufficient. Eight PHC teams interested in improving and expanding the implementation of AA have been coached through several PDSA cycles. However, the personalized support model used is very demanding in terms of capacity and resources. These findings guided the research team in developing and evaluating a Continuous Quality Improvement (CQI) Cohort program on advanced access to support Primary healthcare (PHC) teams.This study aims to develop knowledge on an externally facilitated CQI pan-Canadian cohort program that could potentially be transferred to provincial organizations or professional associations wishing to support clinics in quality improvement projects.

OBJECTIVE: Assess the effectiveness of CQI cohorts on AA outcomes.

QI INTERVENTION PROGRAM: PHC teams will participate in an externally facilitated CQI program focusing on AA. The proposed program consists of cycle of three key activities; 1) Interprofessional reflective sessions and need prioritization, 2) Group mentoring and PDSA Cycles and 3) Cohort cross-learning exchange opportunities.

METHODS: This study will be based on the cluster-controlled trial of a CQI program of PHC teams on AA. 48 PHC teams from Quebec will participate to the externally facilitated CQI cohort intervention. Volunteer clinics from the intervention regions will receive the CQI intervention for 18 months. Intervention clinics will be matched to PHC clinics located in other regions to compose the control group. The match will be based on the clinic level (1 to 10, based on the number of patients registered and services offered. Clinics in the control group will receive an audit on a selection of AA indicators and will be offered the intervention 12 to 18 months following their recruitment. Data collection and analysis will include quantitative data based on a comprehensive assessment of both AA processes and outcomes. These will be measured through a self-reflective survey for PHC team members, EMR data and patients related outcomes questionnaire on access. Qualitative data based on semi-structured interviews with key stakeholders, observations of the CQI activities and analysis of plans of action of documents plan of action will take place.

Eligibility criteria: Inclusion criteria:

* Clinics must offer interprofessional care.
* At least 50 % of all team members should accept to take part in the study.

Exclusion criteria:

* Solo Practice Physicians
* Physician-nurse only model

Primary outcomes:
measure: 3rd next available appointment (weekly)
timeFrame: 18 month
measure: Percent of relational continuity (monthly)
timeFrame: 18 month
Secondary outcomes:
measure: Percent of 48-hour open slots (weekly)
timeFrame: 18 month
measure: Use of walk-in (monthly)
timeFrame: 18 month
measure: Proportion of multidisciplinary involvement (monthly)
timeFrame: 18 month
measure: Discontinuity for chronic patients (monthly)
timeFrame: 18 month
measure: 3rd next available appointment (weekly)
timeFrame: 12 month
measure: Percent of relational continuity (monthly)
timeFrame: 12 month
Other outcomes:
Locations:
city: Gaspé
country: Canada
facility: CISSS de la Gaspésie
state: Quebec
city: Gatineau
country: Canada
facility: CISSS de l'Outaouais
state: Quebec
city: Joliette
country: Canada
facility: CISSS de Lanaudière
state: Quebec
city: Laval
country: Canada
facility: CISSS de Laval
state: Quebec
city: Longueuil
country: Canada
facility: CIUSSS de Montérégie-Centre
state: Quebec
city: Lévis
country: Canada
facility: CISSS de Chaudière-Appalaches
state: Quebec
city: Montréal
country: Canada
facility: CIUSSS de l'Est-de-l'Île-de-Montréal
state: Quebec
city: Montréal
country: Canada
facility: CIUSSS de l'Ouest-de-l'Île-de-Montréal
state: Quebec
city: Montréal
country: Canada
facility: CIUSSS du Centre-Ouest-de-l'Île-de-Montréal
state: Quebec
city: Montréal
country: Canada
facility: CIUSSS du Centre-Sud-de-l'Île-de-Montréal
state: Quebec
city: Montréal
country: Canada
facility: CIUSSS du Nord-de-l'Île-de-Montréal
state: Quebec
city: Rouyn-Noranda
country: Canada
facility: CISSS de l'Abitibi-Témiscamingue
state: Quebec
city: Saint-Hubert
country: Canada
facility: CISSS de la Montérégie-Ouest
state: Quebec
city: Saint-Hyacinthe
country: Canada
facility: CISSS de la Montérégie-Est
state: Quebec
city: Saint-Jérôme
country: Canada
facility: CISSS des Laurentides
state: Quebec
city: Sherbrooke
country: Canada
facility: CIUSSS de l'Estrie-CHUS
state: Quebec
city: Trois-Rivières
country: Canada
facility: CIUSSS de la Mauricie et Centre-du-Québec
state: Quebec
city: Québec
country: Canada
facility: CIUSSS de la Capitale-Nationale
Study officials:
affiliation: Université de Sherbrooke
name: Mylaine Breton, PhD
role: PRINCIPAL_INVESTIGATOR
References: