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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2006 October 1; 56(531): 781–787.
PMCID: PMC1920719

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial

Yvonne Engels, PhD, Researcher, Pieter van den Hombergh, MD, PhD, GP, Henk Mokkink, PhD, Methodologist, Henk van den Hoogen, Statistician, Wil van den Bosch, MD, PhD, GP, and Richard Grol, PhD, Director, Centre for Quality of Care Research



To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management.

Design of study

Randomised controlled trial.


Twenty-six intervention and 23 control primary care practices in the Netherlands.


Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later.


Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant.


The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument.

Keywords: continuous quality improvement, practice management, primary healthcare, randomized controlled trial

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners