title: What Influences Participation in QI? A Randomized Trial of Addiction Treatment Organizations.
abstract: Healthcare providers have increased the use of quality improvement (QI) techniques, but organizational variables that affect QI uptake and implementation warrant further exploration. This study investigates organizational characteristics associated with clinics that enroll and participate over time in QI. The Network for the Improvement of Addiction Treatment (NIATx) conducted a large cluster-randomized trial of outpatient addiction treatment clinics, called NIATx 200, which randomized clinics to one of four QI implementation strategies: (1) interest circle calls, (2) coaching, (3) learning sessions, and (4) the combination of all three components. Data on organizational culture and structure were collected before, after randomization, and during the 18-month intervention. Using univariate descriptive analyses and regression techniques, the study identified two significant differences between clinics that enrolled in the QI study (n = 201) versus those that did not (n = 447). Larger programs were more likely to enroll and clinics serving more African Americans were less likely to enroll. Once enrolled, higher rates of QI participation were associated with clinics' not having a hospital affiliation, being privately owned, and having staff who perceived management support for QI. The study discusses lessons for the field and future research needs.
authors.forename: Kyle L
authors.initials: KL
authors.lastname: Grazier
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Quanbeck
authors.forename: John
authors.initials: J
authors.lastname: Oruongo
authors.forename: James
authors.initials: J
authors.lastname: Robinson
authors.forename: James H
authors.initials: JH
authors.lastname: Ford
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Alice
authors.initials: A
authors.lastname: Pulvermacher
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Johnson
authors.forename: David H
authors.initials: DH
authors.lastname: Gustafson
mesh_terms: D001741:Black or African American; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards; D016000:Cluster Analysis; D006801:Humans; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000379:methods; D058996:Quality Improvement / Q000592:standards* / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011897:Random Allocation; D012044:Regression Analysis; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States