Positive and negative spillovers of the Health Disparities Collaboratives in federally qualified health centers: staff perceptions.
BACKGROUND
Quality improvement (QI) interventions are usually evaluated for their intended effect; little is known about whether they generate significant positive or negative spillovers.


METHODS
We mailed a 39-item self-administered survey to the 1256 staff at 135 federally qualified health centers (FQHC) implementing the Health Disparities Collaboratives (HDC), a large-scale QI collaborative intervention. We asked about the extent to which the HDC yielded improvements or detriments beyond its condition(s) of focus, particularly for non-HDC aspects of patient care and FQHC function.


RESULTS
Response rate was 68.7%. The HDC was perceived to improve non-HDC patient care and general FQHC functioning more often than it was regarded as diminishing them. In all, 45% of respondents indicated that the HDC improved the quality of care for chronic conditions not being emphasized by the HDC; 5% responded that the HDC diminished that quality. Seventy-five percent stated that the HDC improved care provided to patients with multiple chronic conditions; 4% signified that the HDC diminished it. Fifty-five percent of respondents indicated that the HDC improved their FQHC's ability to move patients through their center, and 80% indicated that the HDC improved their FQHC's QI plan as a whole; 8% and 2% indicated that the HDC diminished these, respectively.


CONCLUSIONS
On balance, the HDC was perceived to yield more positive spillovers than negative ones. This QI intervention appears to have generated effects beyond its condition of focus; QI's unintended effects should be included in evaluations to develop a better understanding of QI's net impact.
Division of General Pediatrics, Department of Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. alyna.chien@childrens.harvard.edu
Alyna T
AT
Chien
Anne C
AC
Kirchhoff
Cynthia T
CT
Schaefer
Elbert S
ES
Huang
Sydney E S
SE
Brown
Loretta
L
Heuer
Jessica
J
Graber
Hui
H
Tang
Lawrence P
LP
Casalino
Marshall H
MH
Chin
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006270:Health Facility Administrators; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration*; D011369:Professional-Patient Relations; D015397:Program Evaluation; D014481:United States