Abstract
BackgroundChronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Yet, evidence points to suboptimal quality of care for these conditions in primary care settings. Quality improvement collaboratives (QICs) are organized, multifaceted interventions that can be effective in improving chronic disease care processes and outcomes. In Quebec, Canada, the Institut national d’excellence en santé et en services sociaux (INESSS) has developed a large-scale QIC province-wide program called COMPAS+ that aims to improve the prevention and management of chronic diseases in primary care. This paper describes the protocol for our study, which aims to evaluate implementation and impact of COMPAS+ QICs on the prevention and management of targeted chronic diseases like diabetes and COPD.MethodsThis is a mixed-methods, integrated knowledge translation study. The quantitative component involves a controlled interrupted time series involving nine large integrated health centres in the province. Study sites will receive one of two interventions: the multifaceted COMPAS+ intervention (experimental condition) or a feedback only intervention (control condition). For the qualitative component, a multiple case study approach will be used to achieve an in-depth understanding of individual, team, organizational and contextual factors influencing implementation and effectiveness of the COMPAS+ QICs.DiscussionCOMPAS+ is a QI program that is unique in Canada due to its integration within the governance of the Quebec healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province. We anticipate that this study will address several important gaps in knowledge related to large-scale QIC projects and generate strong and useful evidence (e.g., on leadership, organizational capacity, patient involvement, and implementation) having the potential to influence the design and optimisation of future QICs in Canada and internationally.
Highlights
Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care
Study objectives The overall aim of this study is to evaluate implementation and impact of COMPAS+ quality improvement collaborative (QIC) for chronic diseases prevention and management in primary care
COMPAS+ is a Quality improvement (QI) program that is unique in Canada due to its integration within the governance of a provincial healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province
Summary
Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Two thirds of all deaths each year are caused by four major chronic diseases: cancer, cardiovascular diseases, diabetes, and chronic obstructive pulmonary disease (COPD) [3] Such chronic diseases adversely impact the lives of millions of Canadians and represent a significant burden to the healthcare system, accounting for over one third of all direct healthcare expenditures and billions of dollars in indirect costs due to lost productivity [2,3,4]. There is a strong consensus in Canada and internationally that primary care has a critical role to play in the prevention and management of chronic diseases [4,5,6,7,8,9] These services act as an important hub for comprehensive care that connects patients to other specialists and community services [10]. There is substantial evidence suggesting that the potential of primary care to effectively prevent and manage chronic conditions has not been realized and that many patients struggle to access high-quality chronic disease care [4, 5, 12,13,14,15,16,17,18]
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