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No single formula may work to improve quality of care through collaborations of community health centers

Once someone develops an approach to improve the quality of health care, it's important to know whether the approach will work within hospitals or other health care facilities. Researchers found that quality improvement collaboratives (QICs) among 40 community health centers (CHCs) could use the Chronic Care Model (CCM) to develop and implement initiatives to improve the quality of asthma, cardiovascular disease, and diabetes care at the CHCs. However, further research is needed to understand how specific activities initiated by these collaboratives can contribute to improving the quality of care.

The researchers collected information on quality improvement initiatives at 40 CHCs participating in one of the federally funded Health Disparities Collaboratives. These groups of health centers were created to improve the quality of care for medically underserved populations. Overall, the centers undertook 1,754 quality improvement activities as part of the Health Disparities Collaborative, averaging just under 44 activities per center.

The CCM subcategories with the largest numbers of improvement activities were community linkage for patients (accessing resources in the community for the immediate benefit of CHC patients) and patient registry (development or improvement of disease-specific patient registries). Patient registry was the only subcategory with activities undertaken by all of the centers. The researchers rated 50 (3 percent) of the implemented activities as having a "high" or "very high" potential for impact on care quality. These projects mostly fell within the CCM categories of collaborative decisionmaking with patients or institutionalization of guidelines, protocols, and prompts.

Based on their analysis, the researchers conclude that there is not a single, uniform formula for high-impact quality improvement interventions across multiple CHCs. Instead, different sites may require different combinations of initiatives to produce quality improvement. The study was funded in part by the Agency for Healthcare Research and Quality (HS13653).

More details are in "Inside the Health Disparities Collaboratives: A detailed exploration of quality improvement at community health centers," by Ellie Grossman, M.D., M.P.H., Thomas Keegan, Ph.D., Adam L. Lesser, B.A., and others, in the May 2008 Medical Care 46(5), pp. 489-496.

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