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.