title: The impact of a quality improvement program on systems, processes, and structures in medical clinics.
abstract: OBJECTIVE
  We sought to assess whether participation in a quality-improvement collaborative changed care processes, systems, and organization of outpatient human immunodeficiency virus (HIV) clinics.
  
  
  METHODS
  We surveyed clinicians, medical directors, and HIV program administrators before and after an 18-month quality improvement collaborative at 54 intervention and 37 control clinics providing HIV care. Surveys assessed clinic structures, processes, systems, and culture. During the collaborative, a clinician-administrator team from each intervention clinic attended 4 2-day sessions on quality improvement techniques. Conference calls, a website, and an e-mail list provided support and facilitated communication among collaborative participants.
  
  
  RESULTS
  Survey response rates were 85% or greater. Six of 54 organizational measures differed significantly between baseline and follow-up. Intervention clinicians reported greater computer availability (82% vs. 67%, P = 0.03) and use (3.13 vs. 2.68, P = 0.02; 4-point scale), attended more local (14.2 vs. 8.6, P < 0.01) and national (4.1 vs. 2.9, P = 0.01) conferences, and rated leaders' ability to implement quality improvement higher (3.8 vs. 3.4, P = 0.01; 5-point scale). Intervention directors were more likely to compare quality data to other clinics (79% vs. 54%, P = 0.04). For the set of 54 measures, intervention clinics were more likely to have higher post-intervention scores than controls (sign test, mean = 14.5, P < 0.0001).
  
  
  CONCLUSIONS
  A quality-improvement collaborative for HIV clinics resulted in modest organizational changes. Achieving greater change may require more focused and/or intensive interventions, greater resources for participating clinics, and better developed information technology.
authors: Department of Health Care Policy, Division of General Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA. mcinnes@hcp.med.harvard.edu
authors: D Keith
authors: DK
authors: McInnes
authors: Bruce E
authors: BE
authors: Landon
authors: Ira B
authors: IB
authors: Wilson
authors: Lisa R
authors: LR
authors: Hirschhorn
authors: Peter V
authors: PV
authors: Marsden
authors: Faye
authors: F
authors: Malitz
authors: Magda
authors: M
authors: Barini-Garcia
authors: Paul D
authors: PD
authors: Cleary
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards*; D003299:Cooperative Behavior; D005260:Female; D015658:HIV Infections; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008332:Management Quality Circles; D008875:Middle Aged; D009936:Organizational Innovation; D017064:Process Assessment, Health Care; D017749:Total Quality Management; D014481:United States