Using quality indicators to evaluate the effect of implementing an enhanced collaborative care model among a community, primary healthcare practice population

Over the past decade, Nova Scotia has been making important changes to strengthen its primary healthcare (PHC) system. Here we present the results from an observational, retrospective study evaluating the effect of an enhanced collaborative care model, which included team building and the addition of a nurse practitioner (NP) to the team, on the quality of healthcare delivery among a community, PHC population. To guide the evaluation, we used a broad range of national and provincially identified clinical quality-of-care indicators targeting a wide range of preventive and chronic disease management care (targeting process of care, and immediate and secondary outcomes). A total of 392 patient charts were audited (197 pre-period; 195 post-period). Patients included the full spectrum of the practice population - the young, the old, those with chronic conditions and others without. Results support the increasing body of evidence, which indicates improved chronic disease management among patients with targeted chronic conditions, particularly patients diagnosed with diabetes, who receive care through a collaborative practice where a NP is part of the team. In addition, these results also demonstrate the beginning of better preventive care among all patients.