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Does the collaborative model improve care for chronic heart failure?

Steven M Asch1, David W Baker, Joan W Keesey

  • 1VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. sasch@rand.org

Medical Care
|June 23, 2005
PubMed
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Quality improvement collaboratives, like the Institute for Healthcare Improvement

Area of Science:

  • Healthcare Quality Improvement
  • Chronic Disease Management
  • Health Services Research

Background:

  • Collaborative quality improvement efforts are common but lack rigorous evaluation.
  • The Institute for Healthcare Improvement's Breakthrough Series (IHI BTS) is a widely used model.
  • The impact of IHI BTS on chronic heart failure (CHF) care quality needed assessment.

Purpose of the Study:

  • To evaluate the effectiveness of the IHI BTS on the quality of care for patients with CHF.
  • To compare quality improvement in organizations participating in the IHI BTS versus control organizations.

Main Methods:

  • A quasi-experimental design was used, comparing 4 IHI BTS CHF participating organizations with 4 comparable control organizations.
  • Medical records of 489 patients were reviewed using a computerized tool to assess 23 quality indicators.

Related Experiment Videos

  • Performance on quality indicators was compared between baseline and post-intervention periods.

    • Main Results:

    • Participating sites showed significantly greater improvement in 11 of 21 quality indicators compared to control sites.
    • Overall process scores improved by 17% in participating sites versus 1% in control sites (P < 0.0001).
    • Improvements were most substantial in patient education and counseling measures (24% vs -1%, P < 0.0001).

    Conclusions:

    • Organizational participation in disease-targeted collaboratives like the IHI BTS improves care processes for CHF.
    • These programs effectively enhance both medical therapeutics and patient education/counseling.
    • The findings support the broader use of such collaborative models for chronic disease management.