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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
|December 23, 2022
PubMed
Summary

Organizations with prior investment in quality improvement (QI) initiatives effectively supported primary care practices. This investment led to better recruitment, increased facilitation, and improved practice capacity and clinical outcomes.

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 their effectiveness.
  • Prior investment and experience may influence the success of these support organizations.

Purpose of the Study:

  • To examine the association between prior investment in quality improvement (QI) and the effectiveness of organizations providing large-scale external support to primary care practices.

Main Methods:

  • A mixed-methods study analyzed data from 7 EvidenceNOW grantees 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).

Main Results:

  • Cooperatives with high prior experience recruited more diverse practices with lower baseline performance.
  • These organizations delivered more facilitation and achieved greater improvements in practice capacity and smoking cessation rates.
  • Established networks and experienced leadership in high-experience cooperatives explained their superior performance.

Conclusions:

  • Long-term investment in regionwide organizations with established infrastructure and experience is linked to consistent facilitation support.
  • Such investment correlates with enhanced practice capacity and improved clinical outcomes in primary care settings.