Sustaining Quality Improvement in Community Health Centers: Perceptions of Leaders and Staff

Section of General Internal Medicine, Department of Medicine, The University of Chicago, IL 60637, USA.
The Journal of ambulatory care management 10/2008; 31(4):319-29. DOI: 10.1097/01.JAC.0000336551.67922.2f
Source: PubMed


The Health Disparities Collaboratives are the largest national quality improvement (QI) initiatives in community health centers. This article identifies the incentives and assistance personnel believe are necessary to sustain QI. In 2004, 1006 survey respondents (response rate 67%) at 165 centers cited lack of resources, time, and staff burnout as common barriers. Release time was the most desired personal incentive. The highest funding priorities were direct patient care services (44% ranked no. 1), data entry (34%), and staff time for QI (26%). Participants also needed help with patient self-management (73%), information systems (77%), and getting providers to follow guidelines (64%).

Download full-text


Available from: Amy Schlotthauer, Apr 10, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and preventive services using a common approach across specialties. The long-term goal of IPIP is to create an ongoing, sustained system across multiple levels of the health care system to accelerate improvement. IPIP core program components include alignment of leadership and leadership accountability, promotion of partnerships to promote health care quality, development of attractive incentives and motivators, regular measurement and transparent sharing of performance data, participation in organized quality improvement efforts using a standardized model, development of enduring collaborative improvement networks, and practice-level support. A prototype of the program was tested in 2 states from March 2006 to February 2008. In 2008, IPIP began to spread to 5 additional states. IPIP uses the leadership of the medical profession to align efforts to achieve large-scale change and to catalyze the development of an infrastructure capable of testing, evaluating, and disseminating effective approaches directly into practice.
    Journal of Continuing Education in the Health Professions 06/2010; 30(3):187-96. DOI:10.1002/chp.20080 · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article presents the results of an exploratory case study that assessed a multistakeholder alliance's initiative to motivate quality improvement in primary care physician (PCP) practices. The initiative utilized a "pay-for participation" strategy that provided incentives to PCPs to participate in the National Committee for Quality Assurance's Diabetes Physician Recognition Program (DPRP). The intervention took place over a 2-year period in 8 practices with large safety-net populations located in the Rochester, New York area. The outcomes of interest were receipt of DPRP recognition and performance on DPRP measurements by the practices, as well as qualitative information regarding practice decisions about quality improvement. Of 79 physicians who participated, 37 (47%) received DPRP recognition. Receipt of recognition was likely the result of a combination of preexisting performance and improvements in processes made during the project. While sample size prevented hypothesis testing, size of practice was unrelated to receipt of DPRP recognition. All practices with an electronic medical record and a patient registry achieved recognition. Strong physician leadership and the presence of a quality improvement infrastructure were believed to be associated with DPRP recognition. The majority of practices cited the program's honorarium and other incentives as key motivators for participation. Our findings suggest that pay-for-participation may be a viable strategy to promote quality improvement in physician practices. However, absent continuing reinforcement, it is uncertain if such programs can lead to sustained quality improvement activities.
    Population Health Management 06/2010; 13(3):131-8. DOI:10.1089/pop.2009.0035 · 1.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In 2006, the Massachusetts League of Community Health Centers convened a collaborative to systematically improve health care delivery for patients with diabetes in 17 community health centers. Our goal was to identify facilitators of and barriers to success reported by teams that participated in this collaborative. The collaborative's activities lasted 13 months. At their conclusion, we interviewed participating team members. We asked about their teams' successes, challenges, and take-home messages for future collaborative efforts. We organized their responses into common themes by using the Chronic Care Model as a framework. Themes that emerged as facilitators of success included shifting clinic focus to more actively involve patients and to promote their self-management; improving the understanding and implementation of professional guidelines; and expanding staff roles to accommodate these goals. Patient registries were perceived as beneficial but lacking adequate technical support. Other barriers were staffing and time constraints. Cooperative efforts to improve health care delivery for people with diabetes may benefit from educating the health care team about guidelines, establishing a stronger role for the patient as part of the health care team, and providing adequate technical instruction and support for the use of clinical databases.
    Preventing chronic disease 07/2010; 7(4):A83. · 2.12 Impact Factor
Show more