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

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.