Effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study.

BACKGROUND

Multi-institution collaborative quality improvement programs are a well-established and broadly applicable quality improvement strategy, but there is little systematic assessment their effectiveness.

OBJECTIVE

To evaluate the effectiveness of a quality improvement collaborative in improving the quality of care for HIV-infected patients.

DESIGN

Controlled pre- and postintervention study.

SETTING

Clinics receiving funding from the Ryan White Comprehensive AIDS Resources Emergency Act.

PARTICIPANTS

44 intervention clinics and 25 control clinics matched by location (urban or rural), region, size, and clinic type.

MEASUREMENTS

Changes in quality-of-care measures abstracted from medical records of pre- and postintervention samples of patients at each study clinic. Measures examined included use and effectiveness of antiretroviral therapy, screening and prophylaxis, and access to care.

INTERVENTION

A multi-institutional quality improvement collaborative (the "Breakthrough Series").

RESULTS

9986 patients were studied. Clinical and sociodemographic characteristics of the intervention and control patients were similar (P > 0.05). Differences in changes in the quality of care were not statistically significant. The proportion of patients with a suppressed viral load increased by 11 percentage points (from 40.1% to 51.1%) in the intervention group compared with 5.3 percentage points (from 43.6% to 48.8%) in the control group, but this difference was not statistically significant (P = 0.18). In addition, rates of appropriate screening tests and prophylaxis did not differ between intervention and control sites.

LIMITATIONS

It was not possible to perform a pure randomized trial of the intervention or to assess other measures of quality, such as adherence and satisfaction.

CONCLUSIONS

This prospective, matched study of almost 10 000 patients found that a quality improvement collaborative did not significantly affect the quality of care. Additional research is needed to improve methods of teaching and implementing quality improvement programs to achieve better results.