Inside the health disparities collaboratives: a detailed exploration of quality improvement at community health centers

BACKGROUND: Quality improvement collaboratives (QICs) based on the Chronic Care Model (CCM) are widely used models for improving medical care, but there has been little information to date about the specific projects undertaken by participants in these collaboratives and their outcomes. OBJECTIVES: To describe initiatives undertaken by community health centers (CHCs) participating in QICs (the Health Disparities Collaboratives) for asthma, cardiovascular disease, or diabetes, and to determine whether particular features of these initiatives were associated with improvement in health care processes or outcomes. RESEARCH DESIGN: Observational cohort study. DATA SOURCES/STUDY SETTING: Reports of quality improvement (QI) activities and clinical data from 40 CHCs participating in Health Disparities Collaboratives, 2000-2002. MEASURES: Clinical quality scores based on indicators of chronic disease care. RESULTS: Participating CHCs undertook an average of 44 QI activities per center (range, 8-84). These interventions were distributed broadly throughout the elements of the CCM, with particular emphasis on patient registry development and linkages to the surrounding community. Fifty-three percent of the interventions were fully institutionalized and 28% were evaluated by the centers. We found no relationships between improvement in quality and markers of QI activity quantity, intensity, or CCM category. CONCLUSIONS: Organizations participating in QICs fully integrate the CCM components into their QI activities. However, it remains unclear how specific activities pursued under the guidance of the CCM and QICs contribute to quality improvement.