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How Does Prior Experience Pay Off in Large-Scale Quality Improvement Initiatives?

Deborah J Cohen1, Bijal A Balasubramanian2, Stephan Lindner2

  • 1From Department of Family Medicine and Department of Medical and Clinical Epidemiology, Oregon Health & Science University, Portland, OR (DJC); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB, RW); Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR (SL, KJM); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Family Medicine, Oregon Health & Science University Portland, OR (SMS, JDH, MM, RS, DE-H, AB); Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (JRH, BFC); Department of Psychiatry and Department of Family Medicine, Oregon Health & Science University Portland, OR; VHA Office of Rural Health, Department of Veterans Affairs and VA Portland Health Care System, Portland, OR (SSO); HealthPartners Institute, Minneapolis MN (LIS). cohendj@ohsu.edu.

Journal of the American Board of Family Medicine : JABFM
|September 16, 2022
PubMed
Summary

Long-term investment in organizations supporting primary care quality improvement (QI) leads to better facilitation and improved practice capacity. This sustained support enhances clinical outcomes, demonstrating the value of established infrastructure and experience.

Keywords:
Cardiovascular DiseasesLeadershipLinear ModelsPopulation Health ManagementPrimary Health CareQuality ImprovementSurveys and QuestionnairesWorkforce

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Area of Science:

  • Health Services Research
  • Quality Improvement Science
  • Primary Care Management

Background:

  • Organizations delivering external support for primary care quality improvement (QI) vary in effectiveness.
  • Prior investment in these organizations may influence their capacity and impact.

Purpose of the Study:

  • To examine the association between prior investment in organizations and their effectiveness in delivering large-scale external support to primary care practices.
  • To understand how organizational experience influences the implementation and outcomes of quality improvement initiatives.

Main Methods:

  • A mixed-methods study involving 7 EvidenceNOW grantees (Cooperatives) and 1720 recruited practices.
  • Independent variable: Cooperatives' prior experience level (high, medium, low) in large-scale QI delivery.
  • Dependent variables: Facilitation dose, clinical quality (ABCS metrics), and practice capacity (AR score, CPCQ). Analyzed using multivariable regressions and qualitative inductive approach.

Main Results:

  • Cooperatives with high prior QI experience recruited more diverse practices with lower baseline performance.
  • These experienced Cooperatives delivered more facilitation (mean=+20.3 hours) and achieved greater improvements in practice capacity (CPCQ: +2.04) and smoking performance (+6.43%).
  • Established networks and experienced leadership in high-experience Cooperatives explained better recruitment, facilitation delivery, and outcomes.

Conclusions:

  • Long-term investment in regionwide organizations with established infrastructure and experience supports primary care QI.
  • Such investment is linked to consistent facilitation, enhanced practice capacity, and improved clinical outcomes.
  • Sustained organizational capacity is crucial for effective large-scale quality improvement in primary care.