Presenting Author:

Tiffany Brown, M.P.H.

Principal Investigator:

Megan McHugh, Ph.D.

Department:

Emergency Medicine

Keywords:

quality improvement, qualitative evaluation

Location:

Third Floor, Feinberg Pavilion, Northwestern Memorial Hospital

PH2 - Public Health & Social Sciences

Primary Care Clinics’ Perspectives on Improving Cardiovascular Quality of Care

Background: Healthy Hearts in the Heartland (“H3”) is a quality improvement (QI) study investigating interventions in small primary care practices in the Midwest designed to improve clinical quality measures related to cardiovascular disease prevention. Eligible clinicians consented to have their practices randomized to one of two improvement strategies (point-of-care improvement strategies alone, or with population health improvement strategies added). These interventions were executed in partnership with an H3 practice facilitator over a one year period. One component of the evaluation is a qualitative study designed to elicit the experiences and perspectives of clinic members in the initial enrollment wave after completing 6 months of the program. Methods: We recruited eligible clinicians from participating clinics. Eligible clinics received an opt-out email and then up to 6 contacts via phone, mail, or email asking for their participation. When we contacted clinics, we asked to interview someone who was familiar with the H3 program in their clinic. Interviews took place in June-July 2016, were approximately 30 minutes long, and were conducted over the phone and audio-recorded. The interview guide focused on the following areas: (1) reflections on their H3 experience to date, (2) what had been helpful, (3) challenges they’d encountered, and (4) looking ahead to their expectations for their remaining time with the study. Study staff reviewed the tapes and met to review themes. Results: We conducted n=16 interviews (response rate of 59%). Participants were from clinics in Illinois (n=8), Indiana (n=7), and Wisconsin (n=1) and were partnered with 9 different practice facilitators. At the time of the interview, clinics had a mean of 4 visits with their H3 facilitator (range: 1-11). Participants generally described their experience as positive, for example, “[H3 facilitator] makes sure that the time we spend together is valuable,” and ‘When [H3 facilitator] tells me to do something, I do it.” Barriers or challenges to improving cardiovascular quality of care that were identified included lack of time, low patient compliance, and limitations with performance reporting via electronic health records. Only one participant voiced initial disappointment with the program: “I thought [H3 facilitator] was going to bring us more that would improve office flow or recording of data.” Some participants felt that facilitators should be more aggressive pushing clinical staff to adopt more QI interventions, while others recommended patience given heavy demands on these clinics. Conclusions: The majority of participants felt that H3: Healthy Hearts in the Heartland was a positive resource for their clinics. Responses highlighted that facilitators often have to take different approaches to QI work depending on practice preferences and characteristics. Additional interviews will be conducted when practices complete the one year intervention period.