title: IMPROVE: bridge over troubled waters.
abstract: BACKGROUND
  The original collaborative project was described in a 1995 Journal article titled "Competing HMOs Collaborate to Improve Preventive Services." IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) was a large randomized controlled trial using continuous quality improvement to implement clinical systems to improve the delivery of adult preventive services in primary care settings. The project was funded by the Agency for Health Care Policy and Research and initiated as a collaboration between two health maintenance organizations (HMOs) in the Twin Cities: Health Partners and Blue Plus.
  
  
  METHODS
  Forty-four clinics were recruited for the study. Initially the 22 intervention clinics received the multifaceted intervention of leadership support, training on CQI and prevention systems, and consultation and networking opportunities. Next, the comparison clinics received similar assistance, and other clinics were invited into the collaboration. Ultimately, 57 clinics were involved in the project. Multiple collaborations--among clinics, leaders, and HMOs--developed during the project.
  Despite turmoil in the environment during the project, many benefits have been described, including enhanced leadership, growth of systems thinking, better change management skills, and collaboration of competing organizations.
  
  
  CONCLUSIONS
  The IMPROVE collaboration survived and flourished in a very competitive market. It was viewed positively by clinicians, medical clinics, and HMOs, and its benefits have extended into the community.
authors.affiliation: Blue Cross and Blue Shield of Minnesota and Blue Plus, St Paul 55164-0179, USA. smagnan@bcbsmn.com
authors.forename: S
authors.initials: S
authors.lastname: Magnan
authors.forename: L I
authors.initials: LI
authors.lastname: Solberg
authors.forename: T E
authors.initials: TE
authors.lastname: Kottke
authors.forename: A F
authors.initials: AF
authors.lastname: Nelson
authors.forename: G M
authors.initials: GM
authors.lastname: Amundson
authors.forename: S
authors.initials: S
authors.lastname: Richards
authors.forename: M K
authors.initials: MK
authors.lastname: Reed
mesh_terms: D000328:Adult; D018672:Community Health Planning / Q000458:organization & administration*; D003299:Cooperative Behavior; D004465:Economic Competition; D006265:Health Care Coalitions / Q000458:organization & administration*; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D007857:Leadership; D008389:Marketing of Health Services; D008910:Minnesota; D017146:Models, Organizational; D019982:Organizational Case Studies; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D017749:Total Quality Management / Q000458:organization & administration*; D019037:Urban Health Services / Q000458:organization & administration