Which elements of improvement collaboratives are most effective? A cluster‐randomized trial

• DOI: 10.1111/add.12117
• Publication Date: 2013-01-14T14:29:19Z
• Authors: David H. Gustafson; Andrew R. Quanbeck; James M. Robinson; James H. Ford; Alice Pulvermacher; Michael T. French; K. John McConnell; Paul B. Batalden; Kim A. Hoffman; Dennis McCarty
• Keywords: Patient Dropouts; Substance-Related Disorders; Interprofessional Relations; Patient Acceptance of Health Care; Quality Improvement; United States; 3. Good health; Time-to-Treatment; 03 medical and health sciences; Ambulatory Care; Telecommunications; Cluster Analysis; Humans; Substance Abuse Treatment Centers; Cooperative Behavior; 0305 other medical science

Improvement collaboratives consisting of various components are used throughout health care to improve quality, but no study has identified which work best. This tested the effectiveness different in addiction treatment services, hypothesizing that a combination all would be most effective.An unblinded cluster-randomized trial assigned clinics one four groups: interest circle calls (group teleconferences), clinic-level coaching, learning sessions (large face-to-face meetings) and three. Interest functioned as minimal intervention comparison group.Out-patient United States.Two hundred five states.Clinic data managers submitted on three primary outcomes: waiting-time (mean days between first contact treatment), retention (percentage patients retained from fourth session) annual number new patients. State group costs were collected for cost-effectiveness analysis.Waiting-time declined significantly coaching (an average 4.6 days/clinic, P = 0.001), (3.5 0.012) (4.7 0.001). The groups increased (19.5%, 0.028; 8.9%, 0.029; respectively). showed significant effect outcomes. None improved significantly. estimated cost per clinic was $2878 versus $7930 combination. Coaching collaborative about equally effective achieving aims, substantially more cost-effective.When trying appears help while other improvement (interest circles sessions) do not seem add further value.