Understanding quality improvement collaboratives through an implementation science lens

PREVENTIVE MEDICINE

卷:129

Article

Rohweder, Catherine¹  Wangen, Mary²  Black, Molly³  Dolinger, Heather⁴  Wolf, Marti⁵  O'Reilly, Carey⁵  Brandt, Heather⁶  Leeman, Jennifer⁷ 

[1] Univ North Carolina Chapel Hill, 200 N Greensboro St,Suite D-15,Room 212, Carrboro, NC 27510 USA

[2] Univ N Carolina, 3005 Carrington Hall,CB 7460, Chapel Hill, NC 27599 USA

[3] Amer Canc Soc Inc, 250 Williams St, Atlanta, GA 30303 USA

[4] Amer Canc Soc Inc, 8300 Hlth Pk Suite 10, Raleigh, NC 27615 USA

[5] North Carolina Community Hlth Ctr Assoc, 4917 Waters Edge Dr,Suite 165, Raleigh, NC 27606 USA

[6] Univ South Carolina, 915 Greene St,Discovery Bldg, Columbia, SC 29208 USA

[7] Univ N Carolina, 4005 Carrington Hall,CB 7460, Chapel Hill, NC 27599 USA

关键词: Quality improvement;    Colorectal neoplasms;    Early detection of cancer;    Capacity building;    Implementation science;    Community health centers;   

DOI  :  10.1016/j.ypmed.2019.105859

来源: Elsevier

【 摘 要 】

Quality improvement collaboratives (QICs) have long been used to facilitate group learning and implementation of evidence-based interventions (EBIs) in healthcare. However, few studies systematically describe implementation strategies linked to QIC success. To address this gap, we evaluated a QIC on colorectal cancer (CRC) screening in Federally Qualified Health Centers (FQHCs) by aligning standardized implementation strategies with collaborative activities and measuring implementation and effectiveness outcomes. In 2018, the American Cancer Society and North Carolina Community Health Center Association provided funding, in-person/virtual training, facilitation, and audit and feedback with the goal of building FQHC capacity to enact selected implementation strategies. The QIC evaluation plan included a pre-test/post-test single group design and mixed methods data collection. We assessed: 1) adoption, 2) engagement, 3) implementation of QI tools and CRC screening EBIs, and 4) changes in CRC screening rates. A post-collaborative focus group captured participants' perceptions of implementation strategies. Twenty-three percent of North Carolina FQHCs (9/40) participated in the collaborative. Health Center engagement was high although individual participation decreased over time. Teams completed all four QIC tools: aim statements, process maps, gap and root cause analysis, and Plan-Do-Study-Act cycles. FQHCs increased their uptake of evidence-based CRC screening interventions and rates increased 8.0% between 2017 and 2018. Focus group findings provided insights into participants' opinions regarding the feasibility and appropriateness of the implementation strategies and how they influenced outcomes. Results support the collaborative's positive impact on FQHC capacity to implement QI tools and EBIs to improve CRC screening rates.

【 授权许可】

Free