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Med Care. 2010 Dec;48(12):1050-6. doi: 10.1097/MLR.0b013e3181f37d46.

Positive and negative spillovers of the Health Disparities Collaboratives in federally qualified health centers: staff perceptions.

Author information

1
Division of General Pediatrics, Department of Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. alyna.chien@childrens.harvard.edu

Abstract

INTRODUCTION:

Quality improvement (QI) interventions are usually evaluated for their intended effect; little is known about whether they generate significant positive or negative spillovers.

METHODS:

We mailed a 39-item self-administered survey to the 1256 staff at 135 federally qualified health centers (FQHC) implementing the Health Disparities Collaboratives (HDC), a large-scale QI collaborative intervention. We asked about the extent to which the HDC yielded improvements or detriments beyond its condition(s) of focus, particularly for non-HDC aspects of patient care and FQHC function.

RESULTS:

Response rate was 68.7%. The HDC was perceived to improve non-HDC patient care and general FQHC functioning more often than it was regarded as diminishing them. In all, 45% of respondents indicated that the HDC improved the quality of care for chronic conditions not being emphasized by the HDC; 5% responded that the HDC diminished that quality. Seventy-five percent stated that the HDC improved care provided to patients with multiple chronic conditions; 4% signified that the HDC diminished it. Fifty-five percent of respondents indicated that the HDC improved their FQHC's ability to move patients through their center, and 80% indicated that the HDC improved their FQHC's QI plan as a whole; 8% and 2% indicated that the HDC diminished these, respectively.

DISCUSSION:

On balance, the HDC was perceived to yield more positive spillovers than negative ones. This QI intervention appears to have generated effects beyond its condition of focus; QI's unintended effects should be included in evaluations to develop a better understanding of QI's net impact.

PMID:
20966782
PMCID:
PMC4558100
DOI:
10.1097/MLR.0b013e3181f37d46
[Indexed for MEDLINE]
Free PMC Article
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