Managed Care/Primary Care

Collaboration among competing clinics can enhance adult preventive care

Collaboration between clinics, health organizations, and communities can improve the delivery of adult preventive care services and bridge the gap among health care providers even in a very competitive market, concludes a recent study. The IMPROVE (Improving Prevention Through Organization, Vision, and Empowerment) study was a large randomized controlled trial using continuous quality improvement (CQI) to implement clinical systems based on preventive care guidelines. The goal was to improve the delivery of adult preventive services in primary care settings. The 4-year project was funded by the Agency for Health Care Policy and Research (HS08091) and led by Leif I. Solberg, M.D., of HealthPartners Research Foundation.

The IMPROVE project began in 1993 as a collaboration between two health maintenance organizations (HMOs) in Minneapolis. Leadership support, training in CQI and prevention systems, and consultation and networking opportunities were provided to 22 of 44 clinics that had contracts with one or both of the HMOs. Ultimately, 57 clinics became involved in the project, with multiple collaborations among clinics, leaders, and HMOs. Each IMPROVE clinic developed an interdisciplinary team charged by its own leadership to improve the delivery of at least eight preventive services, such as clinical breast exams and mammograms for women over age 49 and blood pressure and cholesterol tests for people over age 19.

There were regular training and networking meetings for the leaders of the teams from participating clinics. During meetings, clinic team members detailed what they had done since the last session, for example, how they obtained consensus on the guidelines or what they had done to develop tools for prevention screening. Formal and informal collaboration among clinics bridged multiple issues, including competition, leadership and system development needs, even clinic turmoil. For instance, when two-thirds of the IMPROVE clinics experienced a change in ownership or affiliation, the IMPROVE staff were able to continue supporting and encouraging them.

See "IMPROVE: Bridge over troubled waters," by Sanne Magnan, M.D., Ph.D., Dr. Solberg, Thomas E. Kottke, M.D., and others, in the October 1998 Joint Commission Journal on Quality Improvement 24(10), pp. 566-578.

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