Target for improvement: A cluster randomized trial of public involvement in quality indicator prioritization.

Background:

Quality indicators can be used for setting measurable targets for improvement, to monitor and report results, and to ensure that quality improvement activities tackle the most pressing areas for change. Public deliberation have been proposed as a way to integrate lay and expert knowledge, and to increase responsiveness to public expectations and needs, but have not been studied in the context of quality indicator (QI) prioritization.



Objective:

To study the impact of public involvement on quality indicator prioritization.



Design:

Cluster randomized controlled trial.



Method:

In preparation for the trial, we developed a 37-item “menu” of quality indicators for chronic disease prevention and management in primary care, based on a systematic review of existing validated indicator sets. Participating sites (n=6) will be pair-matched and randomized in intervention sites (with public involvement) and control sites (without public involvement). Public representatives will be involved through a structured survey and through participation in a deliberative meeting with clinicians and managers. In control sites, clinicians and managers will prioritize quality indicators among themselves.



Data collection and outcome measures:

Participants’ priorities will be collected at baseline, after deliberation, and at a decision-makers’ meeting held at the end of the trial. Our primary outcome will assess the impact of public involvement on quality indicator choice and agreement with public priorities. We will also collect data on decision-makers’ intention to use the indicators, financial costs of the intervention, and on the public involvement process.



Discussion and expected results:

We hypothesize that public involvement results in greater agreement between quality indicator choice and public priorities. We pilot tested our intervention with 9 public representatives and 8 professionals. Our pilot project demonstrated the feasibility of the intervention and suggested ways to improve the menu of indicators, intervention format, and measurement tools.

We hypothesize that public involvement results in greater agreement between quality indicator choice and public priorities.

Participants’ priorities will be collected at baseline, after deliberation, and at a decision-makers’ meeting held at the end of the trial (planned for nov-dec 2010).

In intervention sites, public representatives participate in a one-day deliberation meeting on quality indicator prioritization along with clinicians and managers. In control groups, quality indicator prioritization is conducted only by clinicians and managers, without public representative involvement.