The Arthritis and Musculoskeletal Quality Improvement Program (AMQUIP): A Breakthrough Series Methodology Project

  • Mastura I


The Australian government had funded the National Primary Care Collaborative (NPCC) program with funding of $14.6million over three years. One of the pilots project was the Arthritis and Musculoskeletal Quality Improvement Program(AMQuIP).The study aims to optimize general practitioners (GPs) management of patients with osteoarthritis (OA) of the hipand knee by identifying gaps between their current practice and best practice. The Breakthrough Series Collaborativemethodology with several Plan-Do-Study-Act (PDSA) cycles was employed. Participants comprises of 12 GPs/practicesfrom two Victorian Divisions of general Practice (one rural, one metropolitan) with 10 patients per GP/practice. GPs/practicesattended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles betweenworkshop and reported results at workshops. GPs/practices reported use of guidelines, change in patient management andchange in practice management/systems. All recruited patients completed the SF-12v2 Health Survey and WOMAC OAIndex Questionnaire twice. Follow up activities including focus groups and face-to-face interviews were held six months afterthe final workshop. All GPs/practices used the guidelines/key messages, introduced “new” management strategies to patients,and made positive changes to their practice management/systems. Patient reported positive changes and outcomes. Byusing a structured methodology and evidence-based guidelines/key messages; GPs can introduce new patient managementstrategies, and by identifying gaps in practice management systems, positive changes can be achieved.


Knight A. The collaborative method. A strategy for improving Australian general practice. Aust Fam Physician. 2004;33(4):269-74.

Groll R. Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001;286(20):2578-85.

Grimshaw J, Eccles M, Walker A, Thomas R. Changing physician behaviour: what works and thoughts on getting more things to work. J Contin Educ Health Prof. 2002;22(4):237-43.

National Service Framework (NSF) for Coronary Heart Disease. Available at :

Øvretveit J, Bate P, Cleary P, et al. Quality collaboratives: lessons learned from research. Quality Saf Health Care. 2005;11(4):345-51.

Institute for Health Care Improvement. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement, 2003. Available at:

Institute for Healthcare Improvement. The Breakthrough Series: IHI’s collaborative model for achieving breakthrough improvement. Diabetes Spectrum. 2004;17:97-101.

Pickin M, O’Cathain A., Dixon S. Evaluation of advanced access in the National Primary Care Collaborative. Br J Gen Pract. 2004;54(502):334-40.

Jones K, Piterman L. The effectiveness of the Breakthrough Series Methodology. Australian Journal of Primary Care. 2008;14(1):59-65.

Arthritis – the bottom line. The economic impact of arthritis in Australia. Canberra: Access Economics Pty Ltd. Arthritis Australia; 2005.

Jones K, Piterman L. Promoting best practice in general practitioner management of osteoarthritis of the hip and knee: Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP). Australian Journal of Primary Care. 2007;13(2):104-12.

Ware J, Kosinki M, Dewey JE. How to score version 2 of the SF-36 Health Survey. Lincoln, RI: Quality Metric Incorporation, 2000. Scoring demonstration. Available at:

American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of hip and knee. Arthritis & Rheumatism. 2000:43(9):1905-15.

How to Cite
IM. (2008). The Arthritis and Musculoskeletal Quality Improvement Program (AMQUIP): A Breakthrough Series Methodology Project. Malaysian Family Physician, 3(2), 4. Retrieved from
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