Setting up improvement projects in small scale primary care practices: feasibility of a model for continuous quality improvement

Objectives-To evaluate the feasibility of a model for continuous quality im provement in small scale general practice and the improvement projects that practices ran after the introduction of continuous quality improvement. Design-A descriptive study. Setting-Twenty general practices in the Netherlands tested the model in an intervention period of 18 months. Intervention-A model for continuous quality improvement adapted for general practice was introduced into the practices using a structured strategy. Pr actices were supported by trained facilitators. Main outcome measures-Acceptance at introduction and continued application of the model; the topics of improvement projects that were set up in the pr actices; whether the improvement projects had been completed; whether they had met the criteria (the use of the "quality cycle" and the Oxford audit s core); and whether the self set objectives had been met. Results-The model was introduced and accepted in all participating practice s. Practices started 51 improvement projects. At the end of the study perio d 33 improvement projects had been completed. Practices chose a wide variet y of objectives for these projects; most of them concerned medical or organ isational topics. Practices started projects mainly because the topic was f elt to be a problem or was causing a bottleneck in the organisation. The qu ality cycle was used in all projects, but practices did not always collect data and evaluate the outcomes. Fourteen projects could be discerned as "fu ll audit". No differences existed in the quality of improvement projects am ong the various types of practice or between the topics addressed. At the e nd of the study period half of the practices continued applying the model. Conclusion-This study showed that the model was feasible for small scale ge neral practice. However, application of the model tended to disintegrate af ter the facilitator had left the practice. Practices succeeded reasonably w ell in running improvement projects. Introduction of continuous quality imp rovement should particularly focus on this. It is suggested that intensive support is necessary to implement and maintain continuous quality improveme nt in small scale practices.