Learning From Statewide Collaborative Quality Initiatives to Advance Equitable Care

Area of Science:

• Health Services Research
• Health Equity Studies
• Quality Improvement Science

Background:

• Health-care quality improvement (QI) initiatives have historically improved health outcomes but often fail to benefit all patient populations equally.
• A significant gap exists in established roadmaps for implementing QI strategies specifically designed to address and reduce health inequities.
• Understanding the experiences of leaders engaged in collaborative quality improvement (CQI) is crucial for developing effective strategies to tackle health disparities.

Purpose of the Study:

• To investigate the experiences of leaders within collaborative quality improvement (CQI) initiatives focused on addressing health inequities.
• To identify the challenges and opportunities encountered by CQI leaders when implementing QI to mitigate the impact of nonmedical drivers on health outcome variability.
• To gather insights that can inform the development of a clearer roadmap for using QI to promote health equity.

Main Methods:

• Conducted semi-structured group and individual interviews with 25 leaders from 12 CQI coordinating centers in Michigan.
• Explored participants' current QI initiatives aimed at evaluating or mitigating nonmedical drivers of health outcome variability.
• Analyzed interview data using a combination of deductive and inductive content analysis, followed by matrix analysis.

Main Results:

• Leaders identified significant challenges in collecting and standardizing data related to nonmedical drivers of health outcomes.
• A notable inconsistency was observed in the understanding and application of health equity principles among CQIs and hospitals.
• Variable patient and hospital access to essential resources hindered efforts to address care gaps and improve quality.

Conclusions:

• CQI leaders face common obstacles in ensuring QI efforts are both accessible and effective for all patient groups.
• Collaborative learning and sharing of identified pathways are essential for overcoming these challenges.
• There is a significant potential for QI to enhance access to high-quality care for all individuals by addressing identified barriers.