# Process evaluation of a data-driven quality improvement program within a cluster randomised controlled trial to improve coronary heart disease management in Australian primary care

## TL;DR

This study evaluated how primary care practices in Australia engaged with a quality improvement program to better manage coronary heart disease.

## Contribution

The study identifies key features of a data-driven quality improvement program that were most effective in engaging primary care practices.

## Key findings

- Learning workshops and monthly feedback reports were the most useful features of the intervention.
- Engagement with the intervention varied across practices, with 69% reporting improved heart disease management.
- Most practices used Plan-Do-Study-Act cycles and accessed an online SharePoint site regularly.

## Abstract

This study evaluates primary care practices’ engagement with various features of a quality improvement (QI) intervention for patients with coronary heart disease (CHD) in four Australian states.

Twenty-seven practices participated in the QI intervention from November 2019 –November 2020. A combination of surveys, semi-structured interviews and other materials within the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease (QUEL) study were used in the process evaluation. Data were summarised using descriptive statistical and thematic analyses for 26 practices.

Sixty-four practice team members and Primary Health Networks staff provided feedback, and nine of the 63 participants participated in the interviews. Seventy-eight percent (40/54) were either general practitioners or practice managers. Although 69% of the practices self-reported improvement in their management of heart disease, engagement with the intervention varied. Forty-two percent (11/26) of the practices attended five or more learning workshops, 69% (18/26) used Plan-Do-Study-Act cycles, and the median (Interquartile intervals) visits per practice to the online SharePoint site were 170 (146–252) visits. Qualitative data identified learning workshops and monthly feedback reports as the key features of the intervention.

Practice engagement in a multi-featured data-driven QI intervention was common, with learning workshops and monthly feedback reports identified as the most useful features. A better understanding of these features will help influence future implementation of similar interventions.

Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.