Confirmatory Results

Quality circles for quality improvement in primary health care: their effectiveness, gaps of knowledge, origins and significance – a scoping review

Adrian Rohrbasser, Janet Harris, Sharon Mickan, Geoff Wong
doi: https://doi.org/10.1101/387605

Abstract

Background Quality circles, or similarly structured small groups in primary health care, such as peer review groups, consist of 6 to 12 professionals from the same background who meet regularly to improve their standard practice. This paper reports the results from a scoping search performed to clarify possible effectiveness, knowledge gaps, underlying concepts and significance.

Objectives To gain insight into knowledge gaps and understanding of the effectiveness, origins and significance of quality circles.

Methods A search strategy was developed starting with ‘quality circle’ in PubMed and the index terms from those articles revealed were then used as search terms to identify further papers. Repeating this process in collaboration with a librarian, search strings relating to quality circles were built, and databases searched up to December 2017. Any paper on structured quality circles or related small group work in primary health care was included when relevant to the objectives.

Results From 11973 citations, 82 background papers and 58 key papers were identified, in addition to 12 books and 10 websites. 19 studies, one paper summarizing three studies and one systematic review suggest that quality circles can be effective in behaviour change, though with varying effect sizes. Quality circles and their techniques are complex, as they are not standardized, and changes seem to depend on the topic and context, which requires further research into how and why they work in order to improve them. From their origins in industry, they are now used in primary health care in many countries for continuous medical education, continuous professional development and quality improvement.

Conclusion The evidence on quality circles indicates that they can successfully change general practitioner behaviour. As they are a complex intervention, theory-driven research approaches are needed to understand and improve their effectiveness. This is of major importance because they play an important role in quality improvement in primary health care in many countries.

Background

Quality circles (QCs), also known as peer review groups, and other structured small groups that exist across Europe, are small groups of health care professionals who meet to reflect and improve their standard practice. They use various didactic methods, such as brain-storming and reflective thinking, and tools for quality improvement (QI), such as audit and feedback or purposeful use of local experts. They are used for quality initiatives in primary health care (PHC) in several European countries (1–10). Scotland and Wales recently introduced structured small groups for QI to replace a pre-existing outcomes-driven incentive scheme (11, 12). It is increasingly being recognized that what is missing from the literature is an account of effectiveness; namely, whether participants change their behaviour or not.

There are systematic reviews (SRs) on the tools used in these groups but there is still doubt as to whether they make participants improve their practice, even if the tools are used in combination. This paper reports the results of a scoping review to map areas of uncertainty regarding QC effectiveness, thereby indicating where further research is needed. It maps size and type of evidence and describes original intentions and reported benefits. To gain additional insight into the potential and significance in different countries, the historical development and drivers of QCs are also reported. The objectives of the scoping review involved several steps and followed the guidelines for conducting systematic scoping reviews (13):

  • mapping the size and type of evidence of the existing literature

  • describing and defining QCs

  • establishing their effectiveness

  • recognizing gaps in knowledge

  • describing their intentions and reported benefits

  • describing their historical development and significance

This paper provides a working definition of QCs and describes their basic properties, effectiveness, knowledge gaps, historical background and significance. The implications of possible knowledge gaps are also discussed.

Methods

Information Sources and Search

Background information, such as basic QC characteristics, reports on their historical development and their spread from industry to the health care sector, was retrieved from 12 relevant textbooks identified by AR, a content expert in the field of QI and associated small group work (14–25).

The literature search, including literature up to December 2017, was performed in several steps by AR. Initially, a limited search was performed in PubMed using the term ‘quality circle’ to identify some papers to be used as a starting point. In collaboration with an experienced librarian, analysis of text words in the title, abstract and indexing helped identify additional search terms. Iterative searching yielded search strings relating to descriptors of QCs, such as ‘quality improvement’, ‘group functions’ or ‘primary care’ (supplementary file S1). Literature was retrieved in Medline, Embase, PsycInfo and CINAHL without language or time restrictions and downloaded to Endnote, a standard software tool for publishing and managing bibliographies, citations and references.

Eligibility Criteria

Any paper on QCs within PHC, with qualitative or quantitative outcomes, or background information, was considered for inclusion. AR screened all papers found during the search process, whilst SM, JH and GW cross-checked them for consistency in the application of the eligibility criteria.

Paper Selection

The quality of data retrieved was only assessed as to whether it provided relevant information about QCs in PHC (26). AR made the relevance assessments, which were then explored in discussions with SM, JH and GW. The following questions were used to assess relevance:

  • Does the paper cover the background of QCs in PHC?

  • Does the paper describe the process in these small groups?

  • Do the papers provide enough data to allow evaluation?

The number of papers excluded and included at each stage is indicated in the flow diagram (Figure 1).

Figure 1:
Figure 1:

paper flow diagram

Data Collection and Reporting

The following types of data were extracted from the documents by AR: authors, year of publication, location, and data describing background, definitions of QCs, their underlying processes and possible effectiveness, historical development and significance in PHC today. The data were then put into a narrative and tables to describe the different aspects of QCs. A data collection template was not used as it was difficult to anticipate how the data would be presented. Data were charted to answer the review objectives.

Results

12 text books were identified, and iterative searches returned 82 background papers and 58 key papers which were deemed eligible and relevant (supplementary files S2, S3 and S4). Additionally, 10 informative websites of various organisations were identified (1–10) as well as 8 papers, after a specific search concerning the research methods of complex interventions, such as small group interventions (27–34). Key papers mainly described or evaluated processes of QCs using research methods, such as systematic reviews (SR), randomised controlled trials (RCT), cohort, or before and after studies. Qualitative studies provided further information on their process and additional benefits. Background papers and the aforementioned websites provided data in reports and summaries on the history, development and significance of QCs.

What QCs are

Within those documents included, the authors identified concurrent key concepts relating to QCs and then agreed on a definition: QCs comprise small groups of 6 to 12 professionals from the same background who meet regularly to reflect on and improve their standard practice (1, 4–6, 8–10, 14, 16–23, 25, 35–46). The terms Practice Based Small Group Work, Peer Review Group, Problem Based Small Group Learning, Practice Based Research Group, Quality Circle, Continuous Medical Education (CME) Group, and Continuous Professional Development (CPD) Group are used interchangeably in different countries. The labelling suggests the basic, original intention of the group, although they may now serve the same purpose. In this scoping review, the term Quality Circle is used as an umbrella term to include all of them.

The groups choose a topic they want to learn more about or a quality aspect which they want to improve in their practice. They decide on how to approach and solve the issue, and they create space for reflective thinking to improve clinical practice (1, 5, 15, 22, 45, 47–55).

The groups also choose their own facilitators, who observe and lead the group through the cycle of QI. Whilst respecting the contribution of each individual, and taking into consideration group dynamics, facilitators try to keep the members focused on the issue without controlling them (19, 22, 56–61).

QC techniques usually comprise a combination of different types of tools, such as the use of educational material discussed in a workshop-like atmosphere, contact with local knowledge experts, audit and feedback on clinical practice with or without outreach visits, facilitation and local consensus processes (36, 37, 42, 43, 46, 54, 55, 62–67). The group may also rehearse clinical skills and use active didactic methods to promote learning, such as brain-storming, reflective thinking, self-monitoring and professional reprocessing of patient situations (1, 7, 8, 10, 18, 23, 25, 68).

The varying tools and didactic methods are usually tailored to the locally prevailing circumstances (30, 54, 68, 69). The number and difficulty of these tools and didactic methods, as well as outcomes and the context of the group, affect the process. Therefore, QCs are complex social interventions (28, 31, 70) that are run in PHC systems and which change constantly with the prevailing economic situation, scientific development and cultural circumstances (27, 30). They incorporate social aspects of the workplace that affect team work, self-determination and involvement in management at a day-to-day level.

Effectiveness

24 quantitative studies and 1 SR were assessed as to whether QCs promote behaviour change. 19 studies, one paper summarizing three studies and one SR from the scoping review suggest that QCs improve individual and group performance in terms of costs, ordering of tests, prescription habits or adherence to clinical practice guidelines (Table 1).

View this table:
Table 1:

Effectiveness of quality circles

20 SRs of high quality and one RCT show that many tools used by QCs predispose professionals to provide care in a different way, enable them to introduce the change, and reinforce it once it has been made (92) (Table 2).

View this table:
Table 2:

Systematic reviews and randomised controlled trials on tools used in quality circles

Knowledge gaps

All authors of SRs showing effect on behaviour change noted considerable variations within and between studies without being able to account for them. It is difficult to explain in SRs why behaviour change happens in QCs (93). A detailed description of the process of intervention of each step is needed to evaluate how and why they may or may not work (95, 98, 100, 103). This is not only necessary for understanding each step but also for understanding combinations of different interventions or steps, such as the use of printed educational material, combined with the use of local opinion leaders, CME workshop and/or outreach visits (101, 103). It is not known which methods should be used, and under what circumstances, to enable QCs to address the reasons for resisting new practices and barriers to them (105). For example, audit and feedback interventions have typically produced heterogeneous effects, and therefore more exploration is needed to determine the underlying reasons for behaviour change, how best to design and deliver this intervention, when and how to use audit and feedback and, finally, how to optimise this in routine practice (110).

As small group work succeeds in CME, the question arises as to how and why this may or may not work for quality projects as well (54). It seems essential to examine what resources small groups offer GPs for changing behaviour (72). In other words, what it is about QCs that influences the clinical performance of GPs. Further studies are needed to find out how they can be tailored to GPs to achieve better results and what group factors are crucial for better outcomes (85). More information is required to determine how often the group process should be repeated, accepting the fact that once may not be enough (51, 90, 110). As there are hardly any theory-based interventions about change in clinical practice, further research should concentrate on improving our understanding of when, how and why interventions, such as education or providing guidelines, are likely to be effective and how to improve them (111).

Intentions and benefits of QCs

Knowledge and skills acquired during initial medical education need to be updated through CME, which aims to promote the application of new knowledge via CPD (93, 98, 112, 113). CME and CPD are necessary prerequisites for QI (114–117).

QI is a data-guided activity that brings about positive change in the delivery of care. It deals with local problems like perceived inefficient, harmful or badly-timed health care (118, 119). In some European countries, QCs seem to play a major role in QI, whereas in others they mainly serve CME and CPD (39).

According to qualitative literature, QCs have a number of benefits. Small group work seems to be the preferred way of learning for GPs (47, 53, 116, 120, 121). The groups help them to link evidence to everyday practice (57), learn how to deal with uncertainty (122) and how to improve practice (54). They are a vehicle for discussing issues and reflecting on practice, that may increase self-esteem (123, 124). Frequent participation strengthens team-based strategies for error prevention (125). Participation in groups can mean someone stepping out of their comfort zone when talking about their own practice performance. This may raise anxiety and generate a stress response (124, 126). This same response, however, seems to improve communication skills and provides an opportunity for learning (61, 127). Several groups of authors note that small groups may be an important factor in preventing burnout and for someone remaining in the same area (50, 61, 91, 128–130).

Origins and Significance of QCs

There are two fundamental concepts that have underpinned the basic understanding of QCs from the beginning of their development: the framework of the Plan-Do-Check-Act Cycle (PDCA) and the social context the group provides for its function (131). In 1924, Shewart created the first table depicting a cycle for continuous control of the QI process (Figure 2) (132). The PDCA cycle is based on the idea that front-line workers often recognize ways of improving production, and will experience increased motivation when given opportunities to participate actively in making those improvements (14, 133). The principles of QI were adopted in health care and presented in three interdependent quality dimensions that interrelate and influence each other: structure, process and outcome. (134).

Figure 2:
Figure 2:

Development of QI Process

Ethical aspects of quality became essential with increasingly discerning patients and public health interests(135) This model of QI in health care was first implemented in in-patient settings and secondary-care clinics in the Netherlands. Development drivers for QCs were the participative group problem-solving approach and the need for shared responsibility for decision-making in fast growing and costly health care systems (136). Ethical aspects of quality became essential with increasingly discerning patients and public health interests

QCs in PHC originated in two centres: McMaster University in Canada, and the University of Nijmegen in the Netherlands. Both promoted Problem Based Learning (PBL) where a group of learners are confronted with a problem they have to solve, making them participate actively in gaining knowledge about a particular issue (137).

At McMaster, a practical method using PBL was presented in 1974, whereby GPs met on a regular basis to exchange thoughts about clinical cases and increase and update their knowledge (138). As these groups were primarily concerned with lifelong learning needs, the technique was called Problem Based Small Group Learning (PBSGL) or CME groups.

In 1979, PBL was also implemented experimentally with small groups of GPs in Nijmegen, who met voluntarily on a regular basis, using their peers to continuously and autonomously improve their knowledge (39). As the Netherlands had adopted Donabedian’s dimensions of quality in health care, their small group work contained features of QI. Gradually, the learning cycle transformed into a cycle of QI, as the focus changed from knowledge gain to using knowledge to improve practice (139, 140). PBL added didactic techniques and industrial small group work added communication skills and knowledge about group dynamics.

In subsequent years, the PBSGL method spread from McMaster, Canada, to Ireland, Scotland and England through the building of networks by teachers, academics and policy makers (2, 6–8, 141). Likewise, the European Society for Quality and Safety in Family Medicine (EQuiP) was founded and served as a communication channel for sharing developments, such as QCs, which spread rapidly from the Netherlands to many other European countries, as well as to the USA, Australia and New Zealand, as shown in Figure 3 (1–10, 39, 74, 83, 122, 124, 142–147). In 2015, EQuiP organised a conference in Fischingen, Switzerland, on QCs in PHC where representatives of these very similar movements documented the range of components, characterised their underlying mechanisms and the local context in which they are conducted.

Figure 3:
Figure 3:

Spread of QCs

Discussion

Summary

QCs can change GP behaviour to varying extents and, within the existing SRs and RCTs, authors note small but significant changes in behaviour. Group work appears to fit GP expectations when it comes to CME, CPD and QI projects, where they play a significant role. QCs developed rapidly as the participative group-problem solving approach and the need for shared responsibility became important in societies with spiralling costs for health care.

Knowledge Gap

The evidence on QCs indicates the existence of substantial knowledge gaps. For example, in studies using methods such as RCT or cohort studies on QCs, or elements thereof, only small and heterogenous effect sizes were noted and it was unclear why these occurred. Further, SRs and RCTs on tools used in QCs have only examined their individual impact or effectiveness. When some have been used in combination, their relative contribution to the overall effect is unclear (107, 108, 111). Finally, it is not known in what way and how many times the process of improvement should be repeated to increase effect sizes(51, 90, 110).

Since QCs embody a complex intervention that is not standardized, and which changes continuously depending on the topic and the context of the group, these results and comments are not surprising (148). Questions regarding the effectiveness of different variations of QC techniques remain unanswered, as well as questions regarding the conditions under which they are most likely to succeed or fail.

Future Research Directions

Complex interventions such as QCs are difficult to examine. One way of doing this is through the use of realist approaches, namely realist review and realist evaluation. These are theory driven approaches that allow questions to be answered about what works; for whom, how, and why – or not, and in what contexts (148, 149). We have built on the findings of this scoping review and are undertaking a realist review to address these knowledge gaps and research needs (150).

Strengths and Limitations

To our knowledge, this is the first summary on the origin, significance and effectiveness of QCs in PHC. This review followed accepted methods for undertaking a scoping review and was done in a systematic manner with inbuilt quality assurance processes. Through multiple searches with the input of an expert librarian, we identified a sufficient range of relevant documents that enabled us to fulfil the objectives of the review. Our review is not and was never intended to be a comprehensive summary of evidence regarding QCs. It was designed to clarify working definitions, characteristics and knowledge gaps with a view to planning further research.

Conclusion

QCs play a major role in CME/CPD and QI. Current evidence indicates that they can be successful but effect size varies substantially. As they are sensitive to local conditions, future research is needed to understand what ingredients and what contextual features lead to successful QCs, using appropriate research techniques such as a realist approach.

Acknowledgement

Nia Roberts, at the Department of Primary Health Care Sciences, Bodleian Libraries, University of Oxford, has contributed substantially to the search strategy of this work.

References

  1. 1.↵
    Diel F. Qualitätszirkel 2013 [German Definition of Structured Small Group Work]. Available from: http://www.kbv.de/html/qualitaetszirkel.php.
  2. 2.↵
    Garbutt D, Dunion L, Walker S, Ford L, Steele D, Tannahill A, et al. Welcome to the Practice Based Small Group Learning (PBSGL) Glasgow: National Health Service Scotland; 2015 [cited 2015 10/09]. PBSGL Home Page]. Available from: http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/patient-safety-and-clinical-skills/safe-results/practice-based-small-group-learning-(pbsgl).aspx.
  3. 3.
    Kirk UB. European Society of Quality and Safety in Primary Health Care (EQuiP): a network organisation within WONCA Region Europe 2015 [Available from: http://equip.woncaeurope.org/.
  4. 4.↵
    Arvidsson GA, Elmroth U. PrimärvardsKvalitet - lanseringen fortsätter! [Quality in primary health care - the launch continues]. Allmän Medicin [Internet]. 2016 25/10/2016 [cited 2016 10/8]; 2. Available from: http://sfam.se/artiklar/primarvardskvalitet-lanseringen-fortsatter.
  5. 5.↵
    Hockl W. Qualitätszirkel 2016 [Austrian Definition of Structured Small Group Work]. Available from: https://oegam.at/qualitaetssicherung-und-qualitaetszirkel.
  6. 6.↵
    Finnegan H. CME Small Group Meetings Dublin: Irish College of General Practitioners (ICPC); 2017 [Irish Structured Small Group Work]. Available from: https://www.icgp.ie/go/courses/cme_small_group_meetings.
  7. 7.↵
    Elmslie T, Armson H, McLeod E, Bordma R, Shaw E, Teeple L, et al. Practice Based Small Group Learning (PBSGL) Hamilton: McMaster; 2017 [Canadian Structured Small Group Work]. Available from: https://www.fmpe.org/.
  8. 8.↵
    Rial J. Practice Based Small Group Learning (PBSGL) Southampton2017 [English Structured Small Group Work]. Available from: https://www.pbsgl.co.uk/.
  9. 9.
    Dressarts T, Martin C. Les Groups de Pairs Paris: SGMF; 2017 [French Structured Small Group Work]. Available from: http://www.sfmg.org/groupe_de_pairs/.
  10. 10.↵
    Rohrbasser A. Qualitätszirkel Bern: SSIM; 2017 [Swiss Definition of Structured Small Group Work]. Available from: http://www.sgaim.ch/de/qualitaet/qualitaetszirkel.html.
  11. 11.↵
    Smith GI, Mercer SW, Gillies JC, McDevitt A. Improving together: a new quality framework for GP clusters in Scotland. British Journal of General Practice. 2017;67(660):294–5.
    OpenUrlFREE Full Text
  12. 12.↵
    Rohrbasser A, Guthrie B, Gillies G, Mercer S. Collaborative Quality Improvement in General Practice Clusters. Report. Glasgow: Scottish School of Primary Care; 2017 03/08/2017. Contract No.: 12.
  13. 13.↵
    Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare. 2015;13(3):141–6.
    OpenUrl
  14. 14.↵
    Ross JE, Ross WC. Japanese quality circles and productivity Reston, Va. : Reston Pub. Co; 1982.
  15. 15.↵
    Ishikawa K. How to Operate Quality Circle Activities. Tokyo: QC Headquarters, Union of Japanese Scientists and Engineers; 1985.
  16. 16.↵
    1. Press OU
    Lawrence M, Schofield T. Medical Audit in Primary Health Care. Press OU, editor: Oxford University Press; 1993.
  17. 17.
    1. Bibliothek DD
    Gerlach FM, Bahrs O. Qualitätssicherung durch hausärtzliche Qualitätszirkel: Strategien zur Etablierung. Bibliothek DD, editor. Berlin: Ullstein Mosby; 1994.
  18. 18.↵
    1. Bahrs O,
    2. Gerlach FM,
    3. Szecsenyi J
    , editors. Ärztliche Qualitätszirkel: Leitfaden für den niedergelassenen Arzt. 2 ed. Köln: Deutscher Ärzteverlag; 1995.
  19. 19.↵
    1. Grol R,
    2. Lawrence M
    , editors. Quality Improvement by Peer Review. Oxford: Oxford University Press; 1995.
  20. 20.
    1. Marinker M
    , editor. Medical Audit and General Practice Second edition ed. London: BMJ Publishing Group; 1995.
  21. 21.
    Fraser R, Mayur L, Baker R. Evidence-Based Audit in General Practice Science E, editor: Butterworth Heinemann; 1999.
  22. 22.↵
    Tross O. Qualitätszirkel als Form der Arbeitsorganisation: Planung und Gestaltung von Qualitätszirkeln als Variante der Teamarbeit in Unternehmen. GRIN, editor. München: Verlag für Akademische Texte; 2003.
  23. 23.↵
    Elwyn G, Greenhalg T, Macfarlane F. Groups. A guide to small group work in healthcare, management, education and research: Radcliffe Medical Press; 2004.
  24. 24.
    Saltman R, Bankauskaite V, Vrangbaek K. Primary care in the driver’s seat?: Organizational reform in European primary care: McGraw-Hill Education (UK); 2005.
  25. 25.↵
    1. Sommers LS,
    2. Launer J
    , editors. Clinical uncertainty in primary care: the challenge of collaborative engagement. London: Springer; 2013.
  26. 26.↵
    Armstrong R, Hall BJ, Doyle J, Waters E. ‘Scoping the scope’ of a cochrane review. Journal of Public Health. 2011;33(1):147–50.
    OpenUrlCrossRefPubMedWeb of Science
  27. 27.↵
    Plsek PE, Greenhalgh T. The challenge of complexity in health care. BMJ : British Medical Journal. 2001;323(7313):625–8.
    OpenUrl
  28. 28.↵
    Mennin S. Small-group problem-based learning as a complex adaptive system. Teaching and Teacher Education. 2007;23(3):303–13.
    OpenUrlCrossRef
  29. 29.
    Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337.
  30. 30.↵
    Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ. 2008;336(7656):1281–3.
    OpenUrlFREE Full Text
  31. 31.↵
    Egan M, Bambra C, Petticrew M, Whitehead M. Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions. Journal of Epidemiology and Community Health. 2009;63(1):4–11.
    OpenUrlAbstract/FREE Full Text
  32. 32.
    Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. International Journal of Nursing Studies. 2013;50(5):587–92.
    OpenUrlCrossRefPubMed
  33. 33.
    Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ : British Medical Journal. 2015;350.
  34. 34.↵
    Fletcher A, Jamal F, Moore G, Evans RE, Murphy S, Bonell C. Realist complex intervention science: Applying realist principles across all phases of the Medical Research Council framework for developing and evaluating complex interventions. Evaluation. 2016;22(3):286–303.
    OpenUrlCrossRef
  35. 35.↵
    Schillemans L, Grande LD, Remmen R. Using quality circles to evaluate the efficacy of primary health care. New Directions for Program Evaluation. 1989;1989(42):19–27.
    OpenUrl
  36. 36.↵
    Gerlach FM, Beyer M, Romer A. Quality circles in ambulatory care: state of development and future perspective in Germany. Int J Qual Health Care. 1998;10(1):35–42.
    OpenUrlCrossRefPubMed
  37. 37.↵
    Ennis K, Harrington D. Quality management in Irish health care. Int J Health Care Qual Assur Inc Leadersh Health Serv. 1999;12(6-7):232–43.
    OpenUrlPubMed
  38. 38.
    Forster DH, Krause G, Gastmeier P, Ebner W, Rath A, Wischnewski N, et al. Can quality circles improve hospital-acquired infection control? J Hosp Infect. 2000;45(4):302–10.
    OpenUrlCrossRefPubMedWeb of Science
  39. 39.↵
    Beyer M, Gerlach FM, Flies U, Grol R, Krol Z, Munck A, et al. The development of quality circles/peer review groups as a method of quality improvement in Europe. Results of a survey in 26 European countries. Fam Pract. 2003;20(4):443–51.
    OpenUrlCrossRefPubMedWeb of Science
  40. 40.
    Ioannidis G, Papaioannou A, Thabane L, Gafni A, Hodsman A, Kvern B, et al. Canadian Quality Circle pilot project in osteoporosis: rationale, methods, and feasibility. Can Fam Physician. 2007;53(10):1694–700.
    OpenUrlAbstract/FREE Full Text
  41. 41.
    Riou F, Piette C, Durand G, Chaperon J. Results of a 12-month quality-circle prescribing improvement programme for GPs. Br J Gen Pract. 2007;57(540):574–6.
    OpenUrlAbstract/FREE Full Text
  42. 42.↵
    Overton GK, McCalister P, Kelly D, MacVicar R. The Practice-based Small Group Learning programme: experiences of learners in multi-professional groups. J Interprof Care. 2009;23(3):262–72.
    OpenUrlPubMed
  43. 43.↵
    Chop I, Eberlein-Gonska M. Übersichtsartikel zum Peer Review Verfahren und seine Einordnung in der Medizin [Overview on peer review techniques]. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2012;106(8):547–52.
    OpenUrl
  44. 44.
    Armson H, Elmslie T, Roder S, Wakefield J. Encouraging Reflection and Change in Clinical Practice: Evolution of a Tool. Journal of Continuing Education in the Health Professions. 2015;35(3):220–31.
    OpenUrl
  45. 45.↵
    Mahlknecht A, Abuzahra ME, Piccoliori G, Enthaler N, Engl A, Sonnichsen A. Improving quality of care in general practices by self-audit, benchmarking and quality circles. Wiener klinische Wochenschrift. 2016;128(19-20):706–18.
    OpenUrl
  46. 46.↵
    Fuchs S, Parthier K, Wienke A, Mau W, Klement A. Fostering needs assessment and access to medical rehabilitation for patients with chronic disease and endangered work ability: Protocol of a multilevel evaluation on the effectiveness and efficacy of a CME intervention for general practitioners. Journal of Occupational Medicine and Toxicology. 2017;12 (1) (no pagination)(21).
  47. 47.↵
    Lesmes-Anel J, Robinson G, Moody S. Learning preferences and learning styles: a study of Wessex general practice registrars. British Journal of General Practice. 2001;51(468):559–64.
    OpenUrlAbstract/FREE Full Text
  48. 48.
    Dahinden A, Rohrbasser A, Ryser O, Zoller M. Definition medizinischer Qualitätszirkel – ein Vernehmlassungstext Eine Neuorientierung der Empfehlungen für die medizinische Qualitätsarbeit in der Schweiz [Definition of structured small group work - acknowledged recommendations for quality improvement in Switzerland]. Primary Care. 2005;5(16):370–2.
    OpenUrl
  49. 49.
    Jensen PM, Trollope-Kumar K, Waters H, Everson J. Building physician resilience. Can Fam Physician. 2008;54(5):722–9.
    OpenUrlAbstract/FREE Full Text
  50. 50.↵
    Jenson CM, Hutchins AJ, Rowlands G. Is small-group education the key to retention of sessional GPs? Education for Primary Care. 2006;17(3):218–26.
    OpenUrl
  51. 51.↵
    Wilcock J, Iliffe S, Griffin M, Jain P, Thune-Boyle I, Lefford F, et al. Tailored educational intervention for primary care to improve the management of dementia: The EV IDEM-ED cluster randomized controlled trial. Trials. 2013;14 (1) (no pagination)(397).
  52. 52.
    Zwald E. Die ARGOMED-Qualitätszirkel 2013 [Definition of Quality Circle in Networks]. Available from: http://www.argomed.ch/qualitaetszirkel.html.
  53. 53.↵
    Francois P, Philibert AC, Esturillo G, Sellier E. [Peer groups: a model for the continuous professional development in general practice]. Presse Medicale. 2013;42(1):e21–7.
    OpenUrl
  54. 54.↵
    Fisher DM, Brenner CJ, Cheren M, Stange KC. Engagement of groups in family medicine board maintenance of certification. Journal of the American Board of Family Medicine: JABFM. 2013;26(2):149–58.
    OpenUrl
  55. 55.↵
    Shears MR. Peer group learning in the context of an innovative postgraduate certificate for GP trainers: enhancing collaborative learning. Education for Primary Care. 2013;24(6):404–9.
    OpenUrl
  56. 56.↵
    1. Bahrs O,
    2. Gerlach FM,
    3. Szecsenyi J
    Weiss-Plumeyer m. Was sollte ein Moderator machen. In: Bahrs O, Gerlach FM, Szecsenyi J, editors. Ärztliche Qualitätszirkel. 2 ed. Köln: Deutscher Ärzte-Verlag; 1995. p. 97–108.
  57. 57.↵
    Watkins C, Timm A, Gooberman-Hill R, Harvey I, Haines A, Donovan J. Factors affecting feasibility and acceptability of a practice-based educational intervention to support evidence-based prescribing: a qualitative study. Fam Pract. 2004;21(6):661–9.
    OpenUrlCrossRefPubMedWeb of Science
  58. 58.
    Dogherty EJ, Harrison MB, Graham ID. Facilitation as a Role and Process in Achieving Evidence-Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence-Based Nursing. 2010;7(2):76–89.
    OpenUrl
  59. 59.
    Baskerville NB, Liddy C, Hogg W. Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings. The Annals of Family Medicine. 2012;10(1):63–74.
    OpenUrlAbstract/FREE Full Text
  60. 60.
    MacVicar R, Guthrie V, O’Rourke J, Sneddon A. Supporting educational supervisor development at the interface: evaluation of a pilot of PBSGL for faculty development. Education for Primary Care. 2013;24(3):178–84.
    OpenUrl
  61. 61.↵
    Nielsen HG, Davidsen AS. Witnesses in the consultation room - Experiences of peer group supervision. Education for Primary Care. 2017;28(5):258–64.
    OpenUrl
  62. 62.↵
    Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995;274(9):700–5.
    OpenUrlCrossRefPubMedWeb of Science
  63. 63.
    Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995;153(10):1423–31.
    OpenUrlAbstract
  64. 64.
    Gerlach FM, Bahrs O, Weiss-Plumeyer M. [Quality circles in family practice--roots, concepts, perspectives]. Fortschr Med. 1994;112(8):56–61.
    OpenUrlPubMed
  65. 65.
    Wakefield J, Herbert CP, Maclure M, Dormuth C, Wright JM, Legare J, et al. Commitment to change statements can predict actual change in practice. J Contin Educ Health Prof. 2003;23(2):81–93.
    OpenUrlCrossRefPubMed
  66. 66.
    Anwar H, Batty H. Continuing Medical Education Strategy for Primary Health Care Physicians in Oman: Lessons to be learnt. Oman Medical Journal. 2007;22(3):33–5.
    OpenUrl
  67. 67.↵
    Niquille A, Ruggli M, Buchmann M, Jordan D, Bugnon O. The nine-year sustained cost-containment impact of Swiss pilot physicians-pharmacists quality circles. Annals of Pharmacotherapy. 2008;44 (4):650–7.
    OpenUrl
  68. 68.↵
    Andres E, Ludt S, Mainz A, Peters-Klimm F. 20 years of quality circles for family practitioners - Stocktaking and perspectives: A workshop report. [German]. Zeitschrift fur Allgemeinmedizin. 2015;91(2):66–70.
    OpenUrl
  69. 69.↵
    Davis MM, Keller S, DeVoe JE, Cohen DJ. Characteristics and lessons learned from practice-based research networks (PBRNs) in the United States. Journal of Healthcare Leadership. 2012;4:107–16.
    OpenUrl
  70. 70.↵
    Egan M, Bambra C, Thomas S, Petticrew M, Whitehead M, Thomson H. The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control. Journal of Epidemiology and Community Health. 2007;61(11):945–54.
    OpenUrlAbstract/FREE Full Text
  71. 71.
    Hartmann P, Grusser M, Jorgens V. Structured public health quality circle on the topic of diabetes management in general practice. [German] Strukturierte kassenarztliche Qualitatszirkel zum Thema Diabetikerbetreuung in der Praxis. Zeitschrift fur arztliche Fortbildung. 1995;89(4):415–8.
    OpenUrlPubMed
  72. 72.↵
    Ioannidis G, Papaioannou A, Thabane L, Gafni A, Hodsman A, Kvern B, et al. The utilization of appropriate osteoporosis medications improves following a multifaceted educational intervention: the Canadian quality circle project (CQC). BMC Medical Education. 2009;9:54.
    OpenUrl
  73. 73.
    Elward K, Blackburn B, Peterson LE, Greenawald M, Hagen MD. Improving quality of care and guideline adherence for asthma through a group self-assessment module. Journal of the American Board of Family Medicine. 2014;27(3):391–8.
    OpenUrl
  74. 74.↵
    Goldberg HI, Wagner EH, Fihn SD, Martin DP, Horowitz CR, Christensen DB, et al. A randomized controlled trial of CQI teams and academic detailing: can they alter compliance with guidelines? Joint Commission Journal on Quality Improvement. 1998;24(3):130–42.
    OpenUrl
  75. 75.
    Lagerlov P, Loeb M, Andrew M, Hjortdahl P. Improving doctors’ prescribing behaviour through reflection on guidelines and prescription feedback: a randomised controlled study. Qual Health Care. 2000;9(3):159–65.
    OpenUrlAbstract/FREE Full Text
  76. 76.
    Schneider A, Wensing M, Biessecker K, Quinzler R, Kaufmann-Kolle P, Szecsenyi J. Impact of quality circles for improvement of asthma care: results of a randomized controlled trial. J Eval Clin Pract. 2008;14(2):185–90.
    OpenUrlCrossRefPubMed
  77. 77.
    Jager C, Freund T, Steinhauser J, Stock C, Krisam J, Kaufmann-Kolle P, et al. Impact of a tailored program on the implementation of evidence-based recommendations for multimorbid patients with polypharmacy in primary care practices-results of a cluster-randomized controlled trial. Implementation Science. 2017;12(1):8.
    OpenUrl
  78. 78.
    Dyrkorn R, Gjelstad S, Espnes KA, Lindbaek M. Peer academic detailing on use of antibiotics in acute respiratory tract infections. A controlled study in an urban Norwegian out-of-hours service. Scandinavian Journal of Primary Health Care. 2016;34(2):180–5.
    OpenUrl
  79. 79.
    Welschen I, Kuyvenhoven MM, Hoes AW, Verheij TJ. Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ. 2004;329(7463):431.
    OpenUrlAbstract/FREE Full Text
  80. 80.
    Gjelstad S, Hoye S, Straand J, Brekke M, Dalen I, Lindbaek M. Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study). BMJ. 2013;347:f4403.
    OpenUrlAbstract/FREE Full Text
  81. 81.
    Vervloet M, Meulepas MA, Cals JW, Eimers M, van der Hoek LS, van Dijk L. Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention. NPJ Primary Care Respiratory Medicine. 2016;26:15083.
    OpenUrl
  82. 82.
    Rognstad S, Brekke M, Fetveit A, Dalen I, Straand J. Prescription peer academic detailing to reduce inappropriate prescribing for older patients: a cluster randomised controlled trial. Br J Gen Pract. 2013;63(613):e554–62.
    OpenUrlAbstract/FREE Full Text
  83. 83.↵
    Richards D, Toop L, Graham P. Do clinical practice education groups result in sustained change in GP prescribing? Family Practice. 2003;20(2):199–206.
    OpenUrlCrossRefPubMedWeb of Science
  84. 84.
    Wensing M, Broge B, Kaufmann-Kolle P, Andres E, Szecsenyi J. Quality circles to improve prescribing patterns in primary medical care: what is their actual impact? J Eval Clin Pract. 2004;10(3):457–66.
    OpenUrlCrossRefPubMed
  85. 85.↵
    Wensing M, Broge B, Riens B, Kaufmann-Kolle P, Akkermans R, Grol R, et al. Quality circles to improve prescribing of primary care physicians. Three comparative studies. Pharmacoepidemiology and drug safety. 2009;18(9):763–9.
    OpenUrlCrossRefPubMed
  86. 86.
    Niquille A, Ruggli M, Buchmann M, Jordan D, Bugnon O. The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles. Ann Pharmacother. 2010;44(4):650–7.
    OpenUrlCrossRefPubMed
  87. 87.
    Verstappen WH, van der Weijden T, Sijbrandij J, Smeele I, Hermsen J, Grimshaw J, et al. Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003;289(18):2407–12.
    OpenUrlCrossRefPubMedWeb of Science
  88. 88.
    Verstappen WH, van der Weijden T, Dubois WI, Smeele I, Hermsen J, Tan FE, et al. Improving test ordering in primary care: the added value of a small-group quality improvement strategy compared with classic feedback only. Ann Fam Med. 2004;2(6):569–75.
    OpenUrlAbstract/FREE Full Text
  89. 89.
    Verstappen WH, van Merode F, Grimshaw J, Dubois WI, Grol RP, van der Weijden T. Comparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial. Int J Qual Health Care. 2004;16(5):391–8.
    OpenUrlCrossRefPubMedWeb of Science
  90. 90.↵
    Verbakel NJ, Langelaan M, Verheij TJM, Wagner C, Zwart DL M. Effects of patient safety culture interventions on incident reporting in general practice: A cluster randomised trial a cluster randomised trial. British Journal of General Practice. 2015;65(634):e319–e29.
    OpenUrlAbstract/FREE Full Text
  91. 91.↵
    Zaher E, Ratnapalan S. Practice-based small group learning programs: systematic review. Can Fam Physician. 2012;58(6):637–42, e310-6.
    OpenUrlAbstract/FREE Full Text
  92. 92.↵
    1. Organization WH
    Woodward CA. Improving provider skills. In: Organization WH, editor. Strategies for assisting health workers to modify and improve skills: Developing quality health care - a process of change. Geneva: Evidence and Information for Policy, Department of Organization of Health Services Delivery, World Health Organization; 2000.
  93. 93.↵
    Davis D, O’Brien M, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282(9):867–74.
    OpenUrlCrossRefPubMedWeb of Science
  94. 94.
    Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102.
    OpenUrlCrossRefPubMedWeb of Science
  95. 95.↵
    O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007(4):Cd000409.
  96. 96.
    Bowie P, Pope L, Lough M. A review of the current evidence base for significant event analysis. Journal of Evaluation in Clinical Practice. 2008;14(4):520–36.
    OpenUrlCrossRefPubMed
  97. 97.
    O’Brien MA, Freemantle N, Oxman AD, Wolf F, Davis DA, Herrin J. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001(2):CD003030.
  98. 98.↵
    Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009(2):Cd003030.
  99. 99.
    Harris J. KK, Henegan C. ME, N. R, R. P. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16. Medical Teacher. 2011;33(1):9–23.
    OpenUrl
  100. 100.↵
    Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2011(8):Cd000125.
  101. 101.↵
    Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, et al. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;10:CD004398.
    OpenUrlPubMed
  102. 102.
    Farmer AP, Legare F, Turcot L, Grimshaw J, Harvey E, McGowan JL, et al. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008(3):Cd004398.
  103. 103.↵
    Grimshaw JM, Schunemann HJ, Burgers J, Cruz AA, Heffner J, Metersky M, et al. Disseminating and implementing guidelines: article 13 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proceedings of the American Thoracic Society. 2012;9(5):298–303.
    OpenUrlCrossRefPubMed
  104. 104.
    Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010(3):Cd005470.
  105. 105.↵
    Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to address determinants of practice. Cochrane Database Syst Rev. 2015(4):Cd005470.
  106. 106.
    Parmelli E, Flodgren G, Schaafsma ME, Baillie N, Beyer FR, Eccles MP. The effectiveness of strategies to change organisational culture to improve healthcare performance. Cochrane Database Syst Rev. 2011(1):Cd008315.
  107. 107.↵
    Gill PS, Makela M, Vermeulen KM, Freemantle N, Ryan G, Bond C, et al. Changing doctor prescribing behaviour. Pharmacy world & science : PWS. 1999;21(4):158–67.
    OpenUrl
  108. 108.↵
    Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005(4):Cd003539.
  109. 109.
    Roberts CM, Stone RA, Buckingham RJ, Pursey NA, Lowe D, Potter JM. A randomized trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project: three-year evaluation. J Eval Clin Pract. 2012;18(3):599–605.
    OpenUrlPubMed
  110. 110.↵
    Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012(6):Cd000259.
  111. 111.↵
    Cadogan SL, Browne JP, Bradley CP, Cahill MR. The effectiveness of interventions to improve laboratory requesting patterns among primary care physicians: a systematic review. Implement Sci. 2015;10:167.
    OpenUrl
  112. 112.↵
    Nambiar RM. Professional development--in a changing world. Singapore medical journal. 2004;45(12):551–7.
    OpenUrlPubMed
  113. 113.↵
    Davis D. Continuing education, guideline implementation, and the emerging transdisciplinary field of knowledge translation. J Contin Educ Health Prof. 2006;26(1):5–12.
    OpenUrlCrossRefPubMedWeb of Science
  114. 114.↵
    Czabanowska K, Klemenc-Ketis Z, Potter A, Rochfort A, Tomasik T, Csiszar J, et al. Development of a competency framework for quality improvement in family medicine: a qualitative study. J Contin Educ Health Prof. 2012;32(3):174–80.
    OpenUrlCrossRefPubMed
  115. 115.
    Quasdorf I. Experience exchange in quality circles: No routine approach without recognized training. [German] Erfahrungsaustausch in qualitatszirkeln: Kein stammtisch, sondern anerkannte fortbildung. Deutsches Arzteblatt. 2008;105(5):A206–A9.
    OpenUrl
  116. 116.↵
    Renschler HE. Methods in continuing professional education. Results of a pilot survey of physicians. [German] Methoden fur professionelles Weiterlernen. Ergebnis orientierender Umfragen bei Arzten. Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis. 1992;81(52):1574–85.
    OpenUrl
  117. 117.↵
    Renschler HE. Systematic aspects of problem-based, case-related, practice-oriented, professional continuing education. [German] Systematik des problemorientierten, fallbezogenen, praxisgebundenen, professionellen Weiterlernens. Zeitschrift fur arztliche Fortbildung. 1995;89(4):392–6.
    OpenUrlPubMed
  118. 118.↵
    Ogrinc G, Mooney SE, Estrada C, Foster T, Goldmann D, Hall LW, et al. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care. 2008;17(Suppl_1):i13–32.
    OpenUrlAbstract/FREE Full Text
  119. 119.↵
    Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011;20 Suppl 1:i13–7.
    OpenUrlAbstract/FREE Full Text
  120. 120.↵
    Vollmar HC, Rieger MA, Butzlaff ME, Ostermann T. General Practitioners’ preferences and use of educational media: a German perspective. BMC Health Serv Res. 2009;9:31.
    OpenUrlCrossRefPubMed
  121. 121.↵
    Overton GK, Kelly D, McCalister P, Jones J, MacVicar R. The practice-based small group learning approach: making evidence-based practice come alive for learners. Nurse Education Today. 2009;29(6):671–5.
    OpenUrlPubMed
  122. 122.↵
    Sommers LS, Morgan L, Johnson L, Yatabe K. Practice inquiry: clinical uncertainty as a focus for small-group learning and practice improvement. J Gen Intern Med. 2007;22(2):246–52.
    OpenUrlPubMed
  123. 123.↵
    Overton GK, McCalister P, Kelly D, Macvicar R. Practice-based small group learning: how health professionals view their intention to change and the process of implementing change in practice. Med Teach. 2009;31(11):e514–20.
    OpenUrlCrossRefPubMed
  124. 124.↵
    Frich J, Hoye S, Lindbaek M, Straand J. General practitioners and tutors’ experiences with peer group academic detailing: a qualitative study. BMC Family Practice. 2010;11(1):12.
    OpenUrl
  125. 125.↵
    Gehring K, Schwappach DLB, Battaglia M, Buff R, Huber F, Sauter P, et al. Safety climate and its association with office type and team involvement in primary care. International Journal for Quality in Health Care. 2013;25(4):394–402.
    OpenUrlCrossRefPubMed
  126. 126.↵
    Henriksen K, Hansen EH. The threatened self: general practitioners’ self-perception in relation to prescribing medicine. Soc Sci Med. 2004;59(1):47–55.
    OpenUrlCrossRefPubMedWeb of Science
  127. 127.↵
    Gehring SC, Kandzora J, Jeske-Saathoff E, Laag S, Hofmann W, Steinhauser J. Structured pharmacotherapy in multimorbid seniors - A pilot project. [German]. Zeitschrift fur Allgemeinmedizin. 2017;93(6):266–70.
    OpenUrl
  128. 128.↵
    Brondt A, Sokolowski I, Olesen F, Vedsted P. Continuing medical education and burnout among Danish GPs. British Journal of General Practice. 2008;58(546):15–9.
    OpenUrlAbstract/FREE Full Text
  129. 129.
    Kjaer NK, Steenstrup AP, Pedersen LB, Halling A. Continuous professional development for GPs: experience from Denmark. Postgraduate medical journal. 2014;90(1065):383–7.
    OpenUrlAbstract/FREE Full Text
  130. 130.↵
    Peterson U, Bergstrom G, Samuelsson M, Asberg M, Nygren A. Reflecting peer-support groups in the prevention of stress and burnout: randomized controlled trial. Journal of advanced nursing. 2008;63(5):506–16.
    OpenUrlCrossRefPubMed
  131. 131.↵
    Onglatco MU, Matsui T. The Anatomy of Japanese Quality Circles 1991 [Les circles de Qualité]. Available from: http://civilisations.revues.org/index1666.html.
  132. 132.↵
    Best M, Neuhauser D. Walter A Shewhart, 1924, and the Hawthorne factory. Qual Saf Health Care. 2006;15(2):142–3.
    OpenUrlFREE Full Text
  133. 133.↵
    Deming WE. Deming’s 1950 Lecture to Japanese Management 1950 [Origin of PDSA Cycle]. Available from: http://hclectures.blogspot.com/1970/08/demings-1950-lecture-to-japanese.html.
  134. 134.↵
    Donabedian A. 20 years of research on the quality of medical care, 1964-1984. Salud Publica Mex. 1988;30(2):202–15.
    OpenUrlPubMed
  135. 135.↵
    Wynia MK. Performance measures for ethics quality. Eff Clin Pract. 1999;2(6):294–8.
    OpenUrlPubMed
  136. 136.↵
    Schmele JA, Allen ME, Butler S, Gresham D. Quality Circles in the Public Health Sector: Implementation and Effect. Public Health Nursing. 1991;8(3):190–5.
    OpenUrlPubMed
  137. 137.↵
    Wood DF. Problem based learning. BMJ. 2003;326(7384):328–30.
    OpenUrlFREE Full Text
  138. 138.↵
    Premi JN. Continuing medical education in family medicine: a report of eight years’ experience. Can Med Assoc J. 1974;111(11):1232–3.
    OpenUrlPubMed
  139. 139.↵
    Grol R, Baker R, Wensing M, Jacobs A. Quality Assurance in General Practice: the State of the Art in Europe. Family Practice. 1994;11(4):460–7.
    OpenUrlCrossRefPubMedWeb of Science
  140. 140.↵
    Newton J, Hutchinson A, Steen N, Russell I, Haimes E. Educational potential of medical audit: observations from a study of small groups setting standards. Quality in health care : QHC. 1992;1(4):256–9.
    OpenUrl
  141. 141.↵
    Walsh AE, Armson H, Wakefield JG, Leadbetter W, Roder S. Using a novel small-group approach to enhance feedback skills for community-based teachers. Teaching and learning in medicine. 2009;21(1):45–51.
    OpenUrlPubMed
  142. 142.↵
    Thesen J. Kvalitetsverktoprosjektet 2010 [Quality improvement project 2010] Oslo: NFA; 2010 [updated 10/01/2010. Available from: http://legeforeningen.no/PageFiles/55104/120213%20Kvalitetsverkt%C3%B8yprosjektet.pdf.
  143. 143.
    Goldberg HI, Rund DA, Hopkins JR. The Midpeninsula Health Service: action research using small primary care groups to provide evidence-based medicine that empowers patients while continuously improving quality and lowering costs. Medical care. 2002;40(4 Suppl):II32–9.
    OpenUrlPubMed
  144. 144.
    Parker LE, de Pillis E, Altschuler A, Rubenstein LV, Meredith LS. Balancing participation and expertise: a comparison of locally and centrally managed health care quality improvement within primary care practices. Qualitative Health Research. 2007;17(9):1268–79.
    OpenUrlCrossRefPubMed
  145. 145.
    Williamson M, Cardona-Morrell M, Elliott JD, Reeve JF, Stocks NP, Emery J, et al. Prescribing Data in General Practice Demonstration (PDGPD) project--a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension. BMC Health Services Research. 2012;12:273.
    OpenUrl
  146. 146.
    Griem C, Kleudgen S, Diel F. Qualitätssicherung: Instrumente der kollegialen Qualitätsförderung [Quality assurance: tool for collaborative quality improvement]. Dtsch Arztebl International. 2013;110(26):1310–3.
    OpenUrl
  147. 147.↵
    McKnight A, Mills K. Continuing medical education for general practitioners--a Northern Ireland plan. Ulster Med J. 1992;61(2):157–62.
    OpenUrlPubMed
  148. 148.↵
    Walshe K. Understanding what works--and why--in quality improvement: the need for theory-driven evaluation. Int J Qual Health Care. 2007;19(2):57–9.
    OpenUrlCrossRefPubMedWeb of Science
  149. 149.↵
    Ovretveit J, Gustafson D. Using research to inform quality programmes. BMJ. 2003;326(7392):759–61.
    OpenUrlFREE Full Text
  150. 150.↵
    Rohrbasser A, Mickan S, Harris J. Exploring why quality circles work in primary health care: a realist review protocol. Systematic Reviews. 2013;2(1):110.
    OpenUrl
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Posted August 08, 2018.
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Quality circles for quality improvement in primary health care: their effectiveness, gaps of knowledge, origins and significance – a scoping review
Adrian Rohrbasser, Janet Harris, Sharon Mickan, Geoff Wong
bioRxiv 387605; doi: https://doi.org/10.1101/387605
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