Findings from a national improvement collaborative: are improvements sustained?

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Health Services Research

Background:

• Despite extensive efforts, healthcare quality and patient safety show minimal improvement in broad outcome measures.
• Limited program evaluations and lack of sustained quality improvement (QI) efforts hinder widespread progress.

Purpose of the Study:

• To evaluate the extent to which hospitals in a Veterans Health Affairs QI collaborative achieved and sustained improvements in patient outcomes.
• To assess the long-term impact of QI initiatives beyond the intervention period.

Main Methods:

• Utilized patient-level, risk-adjusted time-series models analyzing pre- and post-intervention data.
• Examined primary outcomes: hospital length of stay (LOS) and discharges before noon.
• Assessed secondary outcomes: 30-day readmission, in-hospital mortality, and 30-day mortality over a 5-year period.

Main Results:

• 35% of hospitals improved LOS, and 46% improved discharges before noon.
• Sustained improvements were observed in 60% of hospitals for LOS but only 32% for discharges before noon.
• Performance was consistent across various hospital sizes and regions.

Conclusions:

• The study identified lower improvement rates compared to typical QI collaborative evaluations.
• A significant finding was the decline in performance for discharges before noon after the collaborative concluded.
• Further research is needed to identify organizational factors enabling sustained quality improvement.