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Cited by 41Primary Care and Health OutcomesHealthcare Quality and ManagementHealth Policy Implementation Science

After the Collaborative Is Over: What Sustains Quality Improvement Initiatives in Primary Care Practices?

Bray, Paul, Cummings, Doyle M., Wolf, Marti, Massing, Mark W., Reaves, Janet·2009·The Joint Commission Journal on Quality and Patient Safety
DOI 10.1016/s1553-7250(09)35069-2
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Abstract

Background Multisite quality improvement (QI) initiatives, often known as collaboratives, involving primary care practices such as community health centers, academic practices, and managed care groups have been reported. Yet relatively little is known about the sustainability of these QI initiatives after the initial project, and frequently its funding, has ended. A series of practice characteristics that constitute critical elements for QI sustainability activities, as described in a Sustainability Pyramid Model, were proposed.Methods Approximately five months after the cessation of formalized activities of the final collaborative, 25 in-person interviews were conducted in 13 primary care practices that had participated in the three North Carolina Chronic Disease Management collaboratives, which initially involved 33 practices. Clinical outcomes were not considered.Findings Twelve of the 13 practices stated that the collaborative work resulted in improvement in one or more process and/or outcome clinical measures and those improvements have been continued. Five of the 13 practices reported that sustaining improvements had been a challenge since the collaboratives ended. Content analysis of the interviews indicated that the practices variously cited the practice characteristics, as included in the Sustainability Pyramid Model: regular meetings to study practice population data, leadership commitment, availability of infrastructure/staff support, pursuit of additional funding, publicity, and strategic partnerships.Discussion Although the improvement activities initiated during the collaborative were sustained, the process of developing and implementing new QI activities appeared to be more challenging for almost half of the practices. The practices that could accomplish this ongoing new QI process had "institutionalized" their QI strategies--a finding with important implications for sustainability.

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Authors
Bray, P., Cummings, D. M., Wolf, M., Massing, M. W., & Reaves, J.
Affiliations
  • East Carolina University (US)
  • NC Department of Health and Human Services (US)
Corresponding author
Bray, Paul
ORCID
Venue
The Joint Commission Journal on Quality and Patient Safety
Publisher
Elsevier BV
Published
2009-10
Volume
35
Issue
10
Pages
502-AP3
ISSN
1553-7250 (ISSN-L)
DOI
10.1016/s1553-7250(09)35069-2
OpenAlex
W2419603663
Cited by
41
References
16
Citations by year
2025: 1 · 2023: 1 · 2022: 2 · 2020: 3 · 2019: 4 · 2018: 4 · 2017: 1 · 2016: 5 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 5
FWCI
6.64
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Joint Commission Journal on Quality and Patient Safety (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
sustainability of quality improvement, primary care practices, chronic disease management, practice characteristics, leadership commitment, strategic partnership, community health centers
MeSH terms
Attitude of Health Personnel, Chronic Disease, Cooperative Behavior, Humans, Interinstitutional Relations, Primary Health Care, Quality Assurance, Health Care, Program Evaluation, Community Networks

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