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Quality improvement in Primary Care: The New Frontier? A framework for discussion

Quality improvement in Primary Care: The New Frontier? A framework for discussion. Simon de Lusignan Primary Care Informatics St. George’s Hospital Medical School. St George’s:. Primary Care Informatics http://www.gpinformatics.org. Information in the consulting room Data Quality

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Quality improvement in Primary Care: The New Frontier? A framework for discussion

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  1. Quality improvement in Primary Care:The New Frontier?A framework for discussion Simon de Lusignan Primary Care Informatics St. George’s Hospital Medical School www.gpinformatics.org

  2. St George’s: www.gpinformatics.org

  3. Primary Care Informaticshttp://www.gpinformatics.org • Information in the consulting room • Data Quality • Telemonitoring www.gpinformatics.org

  4. Overview • Introduction • Lessons from: • the literature • general practice • quality improvement programmes • NeLH-PC • PCDQ • Conclusions • Four processes, and • Three enablers of quality improvement www.gpinformatics.org

  5. Introduction: www.gpinformatics.org

  6. Introduction: • There are readily identifiable: • processes, and • enablers to promote quality improvement • Learn the lessons from: • the literature • general practice • quality improvement programmes www.gpinformatics.org

  7. Lessons from the literature www.gpinformatics.org

  8. Old think Passively listening to lectures Educator decides topic Read a journal or text book Errors should be forgotten / denied New think Actively participate in learning You decide the topic Problem solving, simulated cases Errors are a learning experience Shift towards learner-centred education Wyatt JC. Clinical Knowledge… in the Information Age London: RSM, 2001 www.gpinformatics.org

  9. Reviews of the evidence point towards certain themes: “Our data show some evidence that interactive CME sessions that that enhance participant activity andprovide the opportunity to practice skills can effect change in professional practice and, on occasion,health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.” Davis D et al. Impact of formal continuing medical education: do… continuing education activities change physician behavior or health care outcomes? JAMA 1999 Sep 1;282(9):867-74 www.gpinformatics.org

  10. Emerging evidence supports complex interventions …the complex educational interventionexemplified the best form of knowledge translation (the integrationof knowledge into practice), moving the practitioner from • awarenessof new guidelines • to agreement with the guidelines and • finallyto adoption and adherence, following well-defined patternsof adoption and based on principles of adult learning appliedto CME. Davis D. Clinical practice guidelines and the translation of knowledge: the science of continuing medical education. CMAJ 2000; 163 (10 ):1278-9 www.gpinformatics.org

  11. Lessons from General Practice www.gpinformatics.org

  12. The biopsychosocial model: "The dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioural dimensions of illness." Engel GL. (1977) The need for a new medical model: a challenge for biomedicine. Science;196(4286):129-36 www.gpinformatics.org

  13. The unique nature of primary care: "Doctors in other parts of medicine are devoted to a particular organ or a technology. They practice according to what the Germans call "Das Schemata"…. …"Das Schemata" is not workable within general practice.“ Fugelli P. (2001) Trust — in general practice. BJGP;51:575-579. www.gpinformatics.org

  14. The primary care consultation: ‘In general practice, the consultation is a journey, not a destination.’ Neighbour misquoting Milton Erickson Neighbour R. The Inner Consultation. How to develop an effective and intuitive consulting style. Manchester: MTP Press, 1987. www.gpinformatics.org

  15. Lessons from two quality improvement programmes… www.gpinformatics.org

  16. Primary Care National electronic Library for healthNeLH-PC • Lots of use up to 750 000 hits per month • No evidence systematically changes practice www.gpinformatics.org

  17. Primary Care Data QualityPCDQ • Single clinical focus • Incremental change • Feedback of own data • Summary data presented to whole PCO www.gpinformatics.org

  18. Conclusions: www.gpinformatics.org

  19. Four key processes for quality improvement in Primary Care: • Access to the evidence • Feedback about your quality of care • Opportunities to share dilemmas • Mentorship www.gpinformatics.org

  20. Three enablers: • Informatics • Effective professional and educational structures • Health service with a vision and appropriate targets www.gpinformatics.org

  21. Thanks for listening… Simon de LUSIGNAN slusigna@sghms.ac.uk www.gpinformatics.org www.gpinformatics.org

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