Patient Safety and Quality

Learning collaboratives are a potentially effective way to improve the quality of care delivered by pediatric practices

Learning collaboratives have the potential to improve the quality of care delivered by pediatric practices, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS11826). Learning collaboratives bring health care provider teams together to learn how to overcome the barriers that impede the delivery of high-quality care within their particular practice. Together, providers learn to identify an explicit quality goal, work with their team to develop innovative plans for change within their system, and use appropriate measurement tools to indicate whether the changes result in the desired improvement.

In the study, 14 Utah pediatric practices participated in a 4-phase learning collaborative. Each practice formed a team that consisted of a pediatrician, a nurse or medical assistant, and a member of the office administrative staff. After conducting an initial audit of 40 medical records (20 for children age 2 and 20 for children age 4) to document preventive services on the basis of national standards, practice teams attended a quality improvement workshop. They were presented with evidence to support the value of preventive services and the results of their audits. They were also taught quality improvement methods such as rapid cycles of change.

Each team developed plans to improve one or more preventive care services. Brief audits with feedback and monthly conference calls were used to support practice to conduct rapid cycles of change, discuss barriers and solutions, and monitor progress. A preventive service score (PSS) assigned one point for each preventive service provided. Based on final chart audits, the PSS improved for all practices after participation in the learning collaborative. Mean PSS for 2-year-olds increased from 4.0 to 4.9 and for 4-year-olds from 3.8 to 5.6. The proportion of children who received 9 of the 10 individual preventive services also improved significantly.

See "Evaluation of a learning collaborative to improve the delivery of preventive services by pediatric practices," by Paul C. Young, M.D., Gordon B. Glade, M.D., Gregory J. Stoddard, M.P.H., and Chuck Norlin, M.D., in the May 2006 Pediatrics 117(5), pp. 1469-1476.

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