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Infrastructure for large-scale quality-improvement projects: early lessons from North Carolina Improving Performance
Warren P Newton1, Ann Lefebvre, Katrina E Donahue
1Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7595, USA. warren_newton@med.unc.edu
Large-scale health care improvement is achievable through a statewide infrastructure and community support. The North Carolina Improving Performance in Practice project demonstrated significant quality gains in chronic disease care across numerous primary care practices.
Area of Science:
- Health Services Research
- Quality Improvement Science
- Primary Care Medicine
Background:
- Limited understanding of scalable health care improvement strategies.
- Need to enhance chronic disease care quality in primary care settings.
Purpose of the Study:
- To implement and evaluate a statewide initiative for improving chronic disease care quality.
- To assess the feasibility of large-scale health care improvement in North Carolina.
Main Methods:
- Utilized common quality measures, shared data systems, rapid cycle improvement, quality-improvement consultants (QICs), learning networks, and aligned incentives.
- Emphasized a community-based strategy and statewide infrastructure development.
- The North Carolina Improving Performance in Practice (IPIP) project involved two waves of practice participation.
Main Results:
- A broad coalition supported the initiative, including professional societies and insurers.
- Significant improvements were observed in diabetes and asthma care measures within 9 months.
- Quality improvements were sustained over one year, with expansion to over 100 practices.
Conclusions:
- Large-scale health care quality improvement is feasible with strong statewide leadership and community infrastructure.
- Practice-collected data and absence of a control group are study limitations.
- Future efforts will focus on sustainability and transforming all primary care practices statewide.
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