title: From community-based pilot testing to region-wide systems change: lessons from a local quality improvement collaborative.
abstract: BACKGROUND
  A community-based collaborative conducted a 2-year pilot study to inform efforts for improving maternal and child health care practice and policy in Allegheny County, Pennsylvania.
  
  
  OBJECTIVE
  (1) To test whether three small-scale versions of an evidence-based, systems improvement approach would be workable in local community settings and (2) to identify specific policy/infrastructure reforms for sustaining improvements.
  
  
  METHODS
  A mixed methods approach was used, including quantitative performance measurement supplemented with qualitative data about factors related to outcomes of interest, as well as key stakeholder interviews and a literature review/Internet search.
  
  
  RESULTS
  Quantitative performance results varied; qualitative data revealed critical factors for the success and failure of the practices tested. Policy/infrastructure recommendations were developed to address specific practice barriers. This information was important for designing a region-wide quality improvement initiative focused on maternal depression.
  
  
  CONCLUSIONS
  The processes and outcomes provide valuable insights for other communities interested in conducting similar quality improvement initiatives.
authors.affiliation: RAND Corporation, RAND-University of Pittsburgh Health Institute, PA, USA.
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Keyser
authors.forename: Harold Alan
authors.initials: HA
authors.lastname: Pincus
mesh_terms: D002675:Child, Preschool; D055812:Community-Based Participatory Research; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008430:Maternal-Child Health Centers; D008507:Medically Underserved Area; D009765:Obesity / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D010414:Pennsylvania; D010865:Pilot Projects; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care