Continuous quality improvement in primary health care: A five year project

Abstract

Background: The aim of the study was to determine the feasibility of a program me of continuous quality improvement (CQI) in three primary care teams (PCTs) and to test the effectiveness of correspondence analysis (CA) in identifying factors contributing to quality performance. Methods: A CQI task force was responsible for coordinating all aspects of the programme. Six domains of performance were defined, each having one or more indicators. The statistical analysis included comparison of proportions and, in addition, CA was used to further identify which factors were contributing to a performance below the standard. Results: In the domain of infant care, two of the three PCTs reached the 100% goal on immunisation coverage. The third PCT did not attain the standard (85%). However, through CA it was possible to identify the subpopulation at risk. The proportion of pregnant women accessing pre- natal care during the first trimester increased from the initial 20 to 66% (p<0.001). Physicians' compliance with pre-natal care protocol increased from 70 to 93% (p<0.05). Performance related to recording of home health care visits in medical histories did not improve at all, nor did the providers reach the standard for continuing education. The medical records information improved for alcohol and tobacco consumption, allergies (p<0.05), and blood pressure(p<0.05). The patients' satisfaction was greater with doctors than nurses. Conclusions: This experience indicates the feasibility and benefits of a comprehensive CQI programme at the primary care level. CA is considered a useful statistical method for locating factors contributing to quality performance.