Improving the quality of dementia care through establishing a quality improvement collaborative of Agents of Change: an interrupted time series study

Kate Laver, Monica Cations, Gorjana Radisic, Lenore de la Perrelle, Richard Woodman, Janna Anneke Fitzgerald, Susan Kurrle, Ian D. Cameron, Craig Whitehead, Jane Thompson, Billingsley Kaambwa, Kate Hayes, Maria Crotty

Research output: Working paper/PreprintPreprint

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Background: Non-pharmacological interventions including physical activity programs, occupational therapy and caregiver education programs have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase guideline adherence to three guideline recommendations.

Methods: We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months and the study used an interrupted time series design to evaluate changes in adherence.

Results: A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project there was a significant increase in clinician adherence to guideline recommendations with a 42.1% immediate increase in adherence (Incidence Rate Ratio =1.42; 95% Confidence Interval =1.08-1.87; p=0.012).

Conclusion: Health professionals working with people with dementia are interested and willing in joining a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care the quality improvement collaborative method was well suited as it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting.
Original languageEnglish
PublisherResearch Square
Number of pages16
Publication statusSubmitted - 31 Mar 2020


  • Health economics and outcomes research
  • Health policy
  • Quality improvement
  • Dementia
  • Clinical practice guidelines


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