Continuous Quality Improvement Cohorts on Advanced Access

February 2, 2023 updated by: Mylaine Breton, Université de Sherbrooke

Impact of Externally Facilitated Continuous Quality Improvement Cohorts on Advanced Access to Support Primary Healthcare Teams

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.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

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.

Study Type

Interventional

Enrollment (Anticipated)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Canada
    • Quebec
      • Gaspé, Quebec, Canada
        • Recruiting
        • CISSS de la Gaspésie
        • Principal Investigator:
          • Mylaine Breton
      • Gatineau, Quebec, Canada, J8T 4J3
        • Recruiting
        • CISSS de l'Outaouais
        • Principal Investigator:
          • Mylaine Breton
        • Contact:
      • Joliette, Quebec, Canada
      • Laval, Quebec, Canada
        • Recruiting
        • CISSS de Laval
        • Contact:
          • Chantal Legris
      • Longueuil, Quebec, Canada
      • Lévis, Quebec, Canada
        • Recruiting
        • CISSS de Chaudière-Appalaches
        • Principal Investigator:
          • Mylaine Breton
        • Contact:
      • Montréal, Quebec, Canada, H1T 2M4
        • Recruiting
        • CIUSSS de l'Est-de-l'Île-de-Montréal
        • Principal Investigator:
          • Mylaine Breton
        • Contact:
      • Montréal, Quebec, Canada
        • Recruiting
        • CIUSSS de l'Ouest-de-l'Île-de-Montréal
        • Principal Investigator:
          • Mylaine Breton
      • Montréal, Quebec, Canada
        • Recruiting
        • CIUSSS du Centre-Ouest-de-l'Île-de-Montréal
        • Contact:
      • Montréal, Quebec, Canada
        • Recruiting
        • CIUSSS du Centre-Sud-de-l'Île-de-Montréal
      • Montréal, Quebec, Canada
        • Recruiting
        • CIUSSS du Nord-de-l'Île-de-Montréal
      • Rouyn-Noranda, Quebec, Canada, J9X 2A9
        • Recruiting
        • CISSS de l'Abitibi-Témiscamingue
        • Principal Investigator:
          • Mylaine Breton
      • Saint-Hubert, Quebec, Canada, J3Y 6W9
      • Saint-Hyacinthe, Quebec, Canada, J2S 4Y8
      • Saint-Jérôme, Quebec, Canada
      • Sherbrooke, Quebec, Canada
      • Trois-Rivières, Quebec, Canada
        • Recruiting
        • CIUSSS de la Mauricie et Centre-du-Québec
        • Principal Investigator:
          • Mylaine Breton
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: HEALTH_SERVICES_RESEARCH
  • Allocation: NON_RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: CQI intervention
The proposed CQI cohort consists of three activities carried out iteratively until the improvement objectives are achieved.
Other: CQI intervention
Activity 1: Reflective sessions and problem prioritisation. Activity 2: PDSA cycles. Activity 3: Group mentoring.
ACTIVE_COMPARATOR: Audit and feedback
Clinics in the control group will receive feedback on six key AA indicators, patients reported experience about access and selected AA processes.
Other: Audit and Feedback
Audit and Feedback on six key AA indicators, patients reported experience about access and selected AA processes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
3rd next available appointment (weekly)
Time Frame: 18 month
Delay before the 3rd next available appointment. The 3rd next available appointment is used (rather than the 1st or 2nd) to decrease variation.
18 month
Percent of relational continuity (monthly)
Time Frame: 18 month
Total number of medical consultations with a patient's attached family physician (or specialised nurse) out of the total number of consultations with any family physician (or specialised nurse) from the clinic. Evaluates relational continuity between the provider and their registered patients.
18 month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percent of 48-hour open slots (weekly)
Time Frame: 18 month
Proportion of appointments available in the next 48 hours. Provides an overview of the provider's ability to respond to urgent care demands.
18 month
Use of walk-in (monthly)
Time Frame: 18 month
Proportion of walk-in visits by registered patients to each professional.
18 month
Proportion of multidisciplinary involvement (monthly)
Time Frame: 18 month
Evaluates the proportion of involvement of different types of providers (social workers, nurses, pharmacists, etc.) with registered patients.
18 month
Discontinuity for chronic patients (monthly)
Time Frame: 18 month
Proportion of chronic patients without any consultations within the last 12 months.
18 month
3rd next available appointment (weekly)
Time Frame: 12 month
Delay before the 3rd next available appointment. The 3rd next available appointment is used (rather than the 1st or 2nd) to decrease variation.
12 month
Percent of relational continuity (monthly)
Time Frame: 12 month
Total number of medical consultations with a patient's attached family physician (or specialised nurse) out of the total number of consultations with any family physician (or specialised nurse) from the clinic. Evaluates relational continuity between the provider and their registered patients.
12 month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Université de Sherbrooke

Collaborators

Isabelle Gaboury
Mike Green
Tara Kiran
Janusz Kaczorowski
Maude Laberge

Investigators

  • Principal Investigator: Mylaine Breton, PhD, Université de Sherbrooke

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

September 21, 2022

Primary Completion (ANTICIPATED)

June 1, 2024

Study Completion (ANTICIPATED)

June 1, 2025

Study Registration Dates

First Submitted

December 21, 2022

First Submitted That Met QC Criteria

February 2, 2023

First Posted (ACTUAL)

February 6, 2023

Study Record Updates

Last Update Posted (ACTUAL)

February 6, 2023

Last Update Submitted That Met QC Criteria

February 2, 2023

Last Verified

February 1, 2023

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • MP-04-2022-696

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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