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Factors Associated with the Successful Implementation of a Quality Improvement Project in Human Immunodeficiency Virus Ambulatory Care Clinics

Center for Health Quality, Outcomes, and Economic Research, VAMC, Bedford, Mass, gwarner{at}dal.ca

Mari-Lynn Drainoni, PhD

Center for Health Quality, Outcomes, and Economic Research, VAMC, Bedford, Mass and Department of Health Services, Boston University School of Public Health, Boston, Mass

Victoria Parker, DBA

Center for Health Quality, Outcomes, and Economic Research, VAMC, Bedford, Mass and Department of Health Services, Boston University School of Public Health, Boston, Mass

Bruce D. Agins, MD, MPH

New York State Department of Health, AIDS Institute, New York, NY

Lois Eldred, DrPH, MPH

HIV/AIDS Bureau and Health Resources Services Administration, United States Department of Health and Human Services, Rockville, Md

We examined a quality improvement (QI) program, offered to ambulatory care clinics (N = 82) serving human immunodeficiency virus-positive clients, to determine what factors predicted the clinic independently implementing QI processes without their program consultant's help. Initial analyses examined clinics at 4 levels of involvement: withdrew from the project, initial QI proficiency, advanced QI proficiency, and consultant independent. The initial and advanced stages were collapsed into 1 group (consultant dependent) and compared with consultant-independent clinics for multivariate logistic regression. In the multivariate models, 3 factors significantly predicted the clinic being consultant independent: staffing level (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2-2.2), the number of participating months (OR = 1.4, 95% CI = 1.0-2.0), and baseline QI readiness (OR = 1.1, 95% CI = 1.0-1.3). Receiver operator curves were calculated for significant predictors; the strongest predictor was staffing (c statistic = .79). Clinics that are organizationally prepared for Q1, allow adequate time to adopt QI methods into their organization, and provide adequate QI staffing are more likely to independently apply QI methods.

Key Words: Human immunodeficiency virus • primary health care • quality of health care

American Journal of Medical Quality, Vol. 19, No. 2, 75-82 (2004)
DOI: 10.1177/106286060401900205


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