Evidence for the impact of quality improvement collaboratives: systematic review

Abstract

Objective To evaluate the effectiveness of quality improvement collaboratives in improving the quality of care. Data sources Relevant studies through Medline, Embase, PsycINFO, CINAHL, and Cochrane databases. Study selection Two reviewers independently extracted data on topics, participants, setting, study design, and outcomes. Data synthesis Of 1104 articles identified, 72 were included in the study. Twelve reports representing nine studies (including two randomised controlled trials) used a controlled design to measure the effects of the quality improvement collaborative intervention on care processes or outcomes of care. Systematic review of these nine studies showed moderate positive results. Seven studies (including one randomised controlled trial) reported an effect on some of the selected outcome measures. Two studies (including one randomised controlled trial) did not show any significant effect. Conclusions The evidence underlying quality improvement collaboratives is positive but limited and the effects cannot be predicted with great certainty. Considering that quality improvement collaboratives seem to play a key part in current strategies focused on accelerating improvement, but may have only modest effects on outcomes at best, further knowledge of the basic components effectiveness, cost effectiveness, and success factors is crucial to determine the value of quality improvement collaboratives.

All teach, all learn, all improve?

“…Despite the popularity of collaboratives, evidence regarding their effectiveness is mixed (Mittman, 2004;Schouten, Hulscher, Everdingen, Huijsman, & Grol, 2008). Whereas some studies find that participating organizations experience significant improvement relative to nonparticipants (e.g., Baier et al, 2004), others find no significant improvement (e.g., Landon et al, 2004) or find improvement on some measures, but not on others, relative to nonparticipants (e.g., Horbar et al, 2004).…”

Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP

“…6 The Institute for Healthcare Improvement (IHI) Breakthrough Collaborative Series is one of the best known and most extensively evaluated collaborative models. 6,7 Several other state-based QI projects, including the Assuring Better Child Health and Development (ABCD) Program, share the IHI's general philosophy and collaborative approach, if not its operational parameters, such as the number and frequency of meetings or the duration of collaboration. 7,8 experts and each other, in part through positive peer pressure.…”

Frailty Assessment in Acute Care

“…Originally proposed by the Institute for Healthcare Improvement, the breakthrough series collaborative methodology(314) sought to provide a collaborative structure for multiple organisations to achieve large scale sustainable improvements through spread and adoption of existing knowledge, expertise and best practice (315). In the United Kingdom, three national collaborative breakthrough networks have current programmes that are potentially impacted by the findings of this thesis.…”