Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years. Final reports of two QICs—one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC’s team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics. The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013. Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries’ functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.

中文翻译：

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根据注册数据对来自不同医疗领域的两个质量改进合作进行深入比较，这可能是导致项目时间以外成果持续改善的可能因素

质量改进合作组织（QIC）被广泛用于改善医疗保健，但是很少有关于长期持续改善结局的研究，而且关于哪些因素促成成功的证据也不一致。这项研究的目的是打开QIC的黑匣子，并比较两种不同QIC的特征和活动，这些特征和活动与基线和随后三年的基线结果变化有关。通过18个QIC特征和4个小组特征对两个QIC的最终报告进行了分析和编码，最终报告包括五个团队的心力衰竭护理和七个团队的骨关节炎护理，包括每个QIC团队的改进项目的详细说明。使用单变量统计数据分析了在2013年（基线），2014年，2015年和2016年定期从瑞典心力衰竭注册中心（SwedeHF）和更好的骨关节炎患者注册管理机构（BOA）收集的每个团队的目标变量。两个QIC的设计差异很大。SwedeHF-QIC聘用了8名专家，运行了12个月，而BOA-QIC聘用了3名专家，运行了6个月。SwedeHF-QIC的活动大约是BOA-QIC的两倍，其范围从团队协调的标准化到更好的信息和有组织的后续行动。结果结果在团队内部以及团队和QIC之间是不同的。两个QIC都受到了参与者的高度赞赏，并为他们的学习做出了贡献，例如改进方法。然而，当QICs在2013年启动时，几个团队已经达到了目标价值。尽管开展了许多QI活动，但是很难看到持续改善的结果。作为需要改进的护理的特定可衡量方面的结果，应谨慎选择。专注于遵守标准护理计划和增加对患者的随访的活动似乎导致了更持久的改善。尽管较早的研究表明，数据跟踪和测量技能以及功能良好的数据仓库有助于持续改进，但是当前的注册管理机构的功能和QIC并不能充分支持这些方面。在项目时间之后，对QIC及其对改进的影响的进一步研究应特别研究这些因素的影响。