Since 2008, the Federation of Health Centers and Coordinated Practice in Auvergne RhĂ´ne-Alpes (FemasAURA\&Co) has been supporting healthcare centers Multiprofessionals (MSPs) in their development in the Auvergne-RhĂ´ne-Alpes (AuRA) region. It aims to support and study the development of the quality approach in MSPs as part of the MSProgress project. The first phase of this project aimed to create a tool to support the quality approach in MSPs. In 2022, a qualitative study using semi-structured group interviews in 7 MSPs followed by a consensus method made it possible to develop a tool composed of quantitative indicators, identified by MSP professionals and queryable in the Health Insurance databases. In 2023, a pilot study was conducted to test the tool prototype with the seven MSPs that participated in its creation, as well as with five MSPs new to the project, in order to gather collective and individual opinions on the design, understanding, and use of this tool. This feedback enabled the finalization of the tool. The second phase of this project aims to evaluate the deployment of the MSProgress tool on a larger scale in MSPs in the AuRA region and to study the selection, monitoring, and analysis of three team indicators over time, with a view to improving their practices. Our hypothesis is that the availability of this tool will encourage a process of improving practices and lead to improved results for the indicators chosen by the teams. The main objective is to evaluate the impact of the MSProgress quality approach support tool on the evolution of the indicators chosen by the MSPs in comparison with standard care. We will use a mixed quantitative and qualitative method. To assess the impact of the provision of the MSProgress quality approach support tool on the evolution of the indicators selected by MSPs, we will conduct a stepped-wedge cluster randomized controlled trial in 60 MSPs in the AURA region, distributed as follows: * "MSP Progress 2024" with the MSProgress tool in 2024-2025-2026 (n=20) * "MSP Progress 2025" with the MSProgress tool in 2025-2026 (n=20) * "MSP Progress 2026" with the tool in 2026 (n=20). MSPs who already participated in the tool development phase and/or the MSProgress pilot study (n=12) will not be considered for randomization but will be followed in a parallel open-label arm. The inclusion of MSPs in the study begins upon receipt of their MSProgress tool. One month later, they will be asked to choose three indicators from the list of 43 proposed by the MSProgress tool. Statistical analyses will focus on the evolution of the three indicators selected by the MSPs between 2021 and 2027, with the years 2021 to 2023 allowing for monitoring the natural evolution of the results. These analyses will be performed at the patient level (resulting from an export of data queried from health insurance databases) (main analysis) and at the MSP level. To assess the methods of choosing and using these indicators in teams and understand what the tool contributes to the quality approach in MSPs, we will conduct a qualitative study with the included MSPs selected by theoretical purposive sampling (these teams will be part of the MSProgress 2024 group of the randomized controlled trial, since the qualitative study will extend over the 3 years of the study). Data collection will be carried out during an annual semi-structured group interview for each MSP over the 3 years of the study by an observer/moderator pair from the research team following the established interview guides. Each interview will be transcribed and the data pseudonymized. The verbatim reports will be submitted for review to the team referent. The analysis will benefit from triangulation by comparing the results of two coders on the NVivo software, according to a grounded theory approach: open, axial and selective coding. Processing this data will enable us to conduct an integrative analysis and propose an explanatory model. At the end of each interview, a questionnaire with an anonymized Likert scale will be distributed to each participant to gather their individual opinions on the format, understanding of the data and results, usage projections, and positioning on the quality approach (data triangulation).
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Percentage of indicators selected at baseline, met at 12 months.
Timeframe: 12 months