title: The role of accountable care organization affiliation and ownership in promoting physician practice participation in quality improvement collaboratives.
abstract: Quality improvement collaboratives (QICs) have emerged as an important strategy to improve processes and outcomes of clinical care through interorganizational learning. Little is known about the organizational factors that support or deter physician practice participation in QICs.
  
  
  
  The aim of this study was to examine organizational influences on physician practices' propensity to participate in QICs. We hypothesized that practice affiliation with an accountable care organization (ACO) and practice ownership by a system or community health center (CHC) would increase the propensity of physician practices to participate in a QIC.
  
  
  
  Data from the third wave of the National Study of Physician Organizations, a nationally representative sample of medical practices (n = 1,359), were analyzed. Weighted multivariate regression analyses were estimated to examine the association of ACO affiliation, ownership, and QIC participation, controlling for practice size, health information technology capacity, public reporting participation, and practice revenue from Medicaid and uninsured patients. The Sobel-Goodman Test was used to explore the extent to which practice use of quality improvement (QI) methods such as Lean, Six Sigma, and use of plan-do-study-act cycles mediates the relationship between ACO affiliation and QIC participation.
  
  
  
  Only 13.6% of practices surveyed in 2012-2013 participated in a QIC. In adjusted analyses, ACO affiliation (odds ratio [OR] = 1.51, p < .01), CHC ownership (OR = 6.57, p < .001), larger practice size (OR = 14.72, p < .001), and health information technology functionality (OR = 1.15, p < .001) were positively associated with QIC participation. Practice use of QI methods partially mediated (13.1%-46.7%) the association of ACO affiliation with QIC participation.
  
  
  
  ACO-affiliated practices are more likely than non-ACO practices to participate in QICs. Practice size rather than system ownership appears to influence QIC participation. QI methods often promoted and used by health care systems such as CHCs and ACOs may promote QIC participation.
authors.affiliation: Vanessa B. Hurley, MPH, MS, is Graduate Student Researcher, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley. E-mail: vbhurley@berkeley.edu. Hector P. Rodriguez, PhD, MPH, is Henry J. Kaiser Endowed Professor, Division of Health Policy and Management, and Co-Director, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley. Stephen M. Shortell, PhD, MPH, MBA, is Blue Cross of California Distinguished Professor, Division of Health Policy and Management, and Co-Director, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Hurley
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration* / Q000592:standards; D003151:Community Health Centers / Q000458:organization & administration / Q000592:standards; D006801:Humans; D010067:Ownership / Q000458:organization & administration*; D011331:Private Practice / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration