Please refer to the disclaimer before reading the case studies.
We instituted a project at the Fairfield GP Unit to improve our care of patients who are known to have coronary artery disease (ie secondary prevention).
We focused on increasing the percentage of patients with established coronary artery disease who had a GP management plan completed in the previous 12 months. We chose this secondary outcome because we believed that if a plan had been completed, a number of issues such as smoking, hypertension, exercise and lipid control would have been addressed.
We undertake a monthly data extraction from our electronic medical records and produce a run chart of the percentage of patients with a GP management plan completed in the last 12 months. This data is then presented to the whole team at our regular monthly practice meeting.
We learned that we needed to improve our coding of patients with coronary artery disease so that we can identify who is or is not receiving good care. We suspect we still haven’t identified all our patients, given the known prevalence of coronary artery disease.
We found that recalling patients improved our figures. By making GP management plan completion rates part of the monthly meetings, we tried to make sure we keep working on this issue.
We would recommend to others to focus on a particular area for improvement and delegate a small team to work on it. An enthusiastic medical student helped us with the project. We used formal quality improvement processes such as the Langley and Nolan ‘Model of Management’ and rapid improvement (PDSA) cycles.
Dr Andrew Knight, Fairfield GP Unit, NSW
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