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

Background: The aim of the study was to determine the feasibilityof a programme of continuous quality improvement (CQI) in threeprimary care teams (PCTs) and to test the effectiveness of correspondenceanalysis (CA) in identifying factors contributing to qualityperformance. Methods: A CQI task force was responsible for coordinatingall aspects of the programme. Six domains of performance weredefined, each having one or more indicators. The statisticalanalysis included comparison of proportions and, in addition,CA was used to further identify which factors were contributingto a performance below the standard. Results: In the domainof infant care, two of the three PCTs reached the 100% goalon immunisation coverage. The third PCT did not attain the standard(85%). However, through CA it was possible to identify the subpopulationat risk. The proportion of pregnant women accessing pre-natalcare during the first trimester increased from the initial 20to 66% (p<0.001). Physicians' compllance with pre-natal careprotocol increased from 70 to 93% (p<0.05). Performance relatedto recording of home health care visits in medical historiesdid not improve at all, nor did the providers reach the standardfor continuing education. The medical records Information improvedfor alcohol and tobacco consumption, allergies (p<0.05),and blood pressure (p<0.05). The patients' satisfaction wasgreater with doctors than nurses. Conclusions: This experienceindicates the feasibllity and benefits of a comprehensive CQIprogramme at the primary care level. CA is considered a usefulstatistical method for locating factors contributing to qualityperformance.