Data-driven quality improvement in primary care: using informatics to implement new prescribing quality measures integrated with educational interventions and existing quality improvement mechanisms

Grant Holders:

University of Dundee

• Professor Bruce Guthrie (PI),
• Professor Peter Donnan,
• Dr Tom Love
• Colin McCowan
• Professor Andrews Morris
• Scott Cunningham
• Professor Peter Davey
• Professor Jeremy Wyatt

NHS Tayside

• Dr Andrew Russell,
• Mrs Lorna Scahill
• Professor Anthony Wells

NHS Fife

• Dr Stella Clark

Funded by CSO NHS Applied Research Programmes for 5 years (£974,645)

Start date 1st April 2009

Aims

The programme has the highly pragmatic aim of designing a complex, primary care prescribing safety and quality improvement intervention, and testing its effectiveness in a cluster randomised trial.

Research Plan

The programme will follow the MRC Framework for Developing and Evaluating Complex Interventions, conducting a series of six studies. The first part of the programme will define the areas of prescribing safety and quality measures to be targeted, and develop and optimise the intervention working with pilot practices.

• Study 1: Modified Delphi study to select prescribing safety and quality measures to target as trial primary outcomes
• Study 2: Qualitative analysis of interviews with professionals to define the quality improvement and governance context, and inform initial design of intervention components
• Study 3: Iterative development of informatics and educational components of the intervention, and negotiation of the quality improvement context within which it will be embedded
• Study 4: Qualitative analysis of interviews with professionals and patients in pilot practices to define trial secondary outcomes, particularly unintended consequences

The second part of the programme will implement and rigorously evaluate the intervention.

• Study 5: Cluster randomised controlled trial in NHS Tayside and NHS Fife to measure intervention effectiveness and conduct economic evaluation
• Study 6: Parallel process evaluation to understand how practice response to intervention mediates effectiveness, to fully document the intervention for generalisation, to examine the impact of collaborative quality improvement work on governance and engagement in primary care, and to explore patient perspectives on data governance and use of clinical data for quality improvement.