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Ann Intern Med. 2004 Jun 1;140(11):887-96.

Effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study.

Author information

1
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA. landon@hcp.med.harvard.edu

Abstract

BACKGROUND:

Multi-institution collaborative quality improvement programs are a well-established and broadly applicable quality improvement strategy, but there is little systematic assessment their effectiveness.

OBJECTIVE:

To evaluate the effectiveness of a quality improvement collaborative in improving the quality of care for HIV-infected patients.

DESIGN:

Controlled pre- and postintervention study.

SETTING:

Clinics receiving funding from the Ryan White Comprehensive AIDS Resources Emergency Act.

PARTICIPANTS:

44 intervention clinics and 25 control clinics matched by location (urban or rural), region, size, and clinic type.

MEASUREMENTS:

Changes in quality-of-care measures abstracted from medical records of pre- and postintervention samples of patients at each study clinic. Measures examined included use and effectiveness of antiretroviral therapy, screening and prophylaxis, and access to care.

INTERVENTION:

A multi-institutional quality improvement collaborative (the "Breakthrough Series").

RESULTS:

9986 patients were studied. Clinical and sociodemographic characteristics of the intervention and control patients were similar (P > 0.05). Differences in changes in the quality of care were not statistically significant. The proportion of patients with a suppressed viral load increased by 11 percentage points (from 40.1% to 51.1%) in the intervention group compared with 5.3 percentage points (from 43.6% to 48.8%) in the control group, but this difference was not statistically significant (P = 0.18). In addition, rates of appropriate screening tests and prophylaxis did not differ between intervention and control sites.

LIMITATIONS:

It was not possible to perform a pure randomized trial of the intervention or to assess other measures of quality, such as adherence and satisfaction.

CONCLUSIONS:

This prospective, matched study of almost 10 000 patients found that a quality improvement collaborative did not significantly affect the quality of care. Additional research is needed to improve methods of teaching and implementing quality improvement programs to achieve better results.

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[Indexed for MEDLINE]

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