Medical Care. 2008 May;46(5):489-96.
Inside the health disparities collaboratives: a detailed exploration of quality improvement at community health centers.
Grossman E, Keegan T, Lessler AL, Ly MH, Huynh L, O'Malley AJ, Guadagnoli E, Landon BE.
Division of General Internal Medicine, New York University School of Medicine, New York, New York, USA. ellie.grossman@med.nyu.edu
Significance:
Quality improvement initiatives based on the Chronic Care Model (CCM) and involving multiple organizations in a “Collaborative” format have become widely used as a means of improving health systems. However, every organization participating in such an effort may implement the CCM principles in a different way, based on their particular local needs. There has been little published information to date about the specific interventions implemented in such Collaboratives, their relationships to aspects of the Chronic Care Model, and whether particular features of the interventions have any relationship to actual quality change.
In our study, we examined the specific interventions at 40 community health centers participating in chronic disease Collaboratives organized by the Institute for Healthcare Improvement in 2000-2002. We found that most organizations undertook interventions involving all aspects of the CCM, but only 53% of interventions were fully institutionalized and 28% were evaluated by the centers. In our exploratory analyses, we found no relationships between intervention intensity or particular aspects of the CCM and change in clinical quality. We need further research to determine whether particular aspects of the Collaborative approach and/or the Chronic Care Model are key determinants of quality improvement, and how there may be synergies between different types of interventions.
Abstract:
BACKGROUND: Quality improvement collaboratives (QICs) based on the Chronic Care Model (CCM) are widely used models for improving medical care, but there has been little information to date about the specific projects undertaken by participants in these collaboratives and their outcomes.
OBJECTIVES: To describe initiatives undertaken by community health centers (CHCs) participating in QICs (the Health Disparities Collaboratives) for asthma, cardiovascular disease, or diabetes, and to determine whether particular features of these initiatives were associated with improvement in health care processes or outcomes.
RESEARCH DESIGN: Observational cohort study.
DATA SOURCES/STUDY SETTING: Reports of quality improvement (QI) activities and clinical data from 40 CHCs participating in Health Disparities Collaboratives, 2000-2002.
MEASURES: Clinical quality scores based on indicators of chronic disease care.
RESULTS: Participating CHCs undertook an average of 44 QI activities per center (range, 8-84). These interventions were distributed broadly throughout the elements of the CCM, with particular emphasis on patient registry development and linkages to the surrounding community. Fifty-three percent of the interventions were fully institutionalized and 28% were evaluated by the centers. We found no relationships between improvement in quality and markers of QI activity quantity, intensity, or CCM category.
CONCLUSIONS: Organizations participating in QICs fully integrate the CCM components into their QI activities. However, it remains unclear how specific activities pursued under the guidance of the CCM and QICs contribute to quality improvement.
PMID: 18438197
