Effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study.
BACKGROUND
Multi-institution collaborative quality improvement programs are a well-established and broadly applicable quality improvement strategy, but there is little systematic assessment their effectiveness.


OBJECTIVE
To evaluate the effectiveness of a quality improvement collaborative in improving the quality of care for HIV-infected patients.


METHODS
Controlled pre- and postintervention study.


METHODS
Clinics receiving funding from the Ryan White Comprehensive AIDS Resources Emergency Act.


METHODS
44 intervention clinics and 25 control clinics matched by location (urban or rural), region, size, and clinic type.


METHODS
Changes in quality-of-care measures abstracted from medical records of pre- and postintervention samples of patients at each study clinic. Measures examined included use and effectiveness of antiretroviral therapy, screening and prophylaxis, and access to care.


METHODS
A multi-institutional quality improvement collaborative (the "Breakthrough Series").


RESULTS
9986 patients were studied. Clinical and sociodemographic characteristics of the intervention and control patients were similar (P > 0.05). Differences in changes in the quality of care were not statistically significant. The proportion of patients with a suppressed viral load increased by 11 percentage points (from 40.1% to 51.1%) in the intervention group compared with 5.3 percentage points (from 43.6% to 48.8%) in the control group, but this difference was not statistically significant (P = 0.18). In addition, rates of appropriate screening tests and prophylaxis did not differ between intervention and control sites.


CONCLUSIONS
It was not possible to perform a pure randomized trial of the intervention or to assess other measures of quality, such as adherence and satisfaction.


CONCLUSIONS
This prospective, matched study of almost 10 000 patients found that a quality improvement collaborative did not significantly affect the quality of care. Additional research is needed to improve methods of teaching and implementing quality improvement programs to achieve better results.
Landon
Bruce E
BE
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA. landon@hcp.med.harvard.edu
Wilson
Ira B
IB
McInnes
Keith
K
Landrum
Mary Beth
MB
Hirschhorn
Lisa
L
Marsden
Peter V
PV
Gustafson
David
D
Cleary
Paul D
PD
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D003625:Data Collection; D015658:HIV Infections / Q000628:therapy* / Q000821:virology; D006801:Humans; D008403:Mass Screening / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D019562:Viral Load