title: Factors associated with the successful implementation of a quality improvement project in human immunodeficiency virus ambulatory care clinics.
abstract: We examined a quality improvement (QI) program, offered to ambulatory care clinics (N = 82) serving human immunodeficiency virus-positive clients, to determine what factors predicted the clinic independently implementing QI processes without their program consultant's help. Initial analyses examined clinics at 4 levels of involvement: withdrew from the project, initial QI proficiency, advanced QI proficiency, and consultant independent. The initial and advanced stages were collapsed into 1 group (consultant dependent) and compared with consultant-independent clinics for multivariate logistic regression. In the multivariate models, 3 factors significantly predicted the clinic being consultant independent: staffing level (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2-2.2), the number of participating months (OR = 1.4, 95% CI = 1.0-2.0), and baseline QI readiness (OR = 1.1, 95% CI = 1.0-1.3). Receiver operator curves were calculated for significant predictors; the strongest predictor was staffing (c statistic = .79). Clinics that are organizationally prepared for QI, allow adequate time to adopt QI methods into their organization, and provide adequate QI staffing are more likely to independently apply QI methods.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, VAMC, Bedford, Mass, USA. gwarner@dal.ca
authors.forename: Grace
authors.initials: G
authors.lastname: Warner
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.forename: Victoria
authors.initials: V
authors.lastname: Parker
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Agins
authors.forename: Lois
authors.initials: L
authors.lastname: Eldred
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003625:Data Collection; D006679:HIV Seropositivity; D006801:Humans; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care