Quality Improvement: A Systems Approach to Reducing Health Disparities

Background:  Implementing national screening recommendations are important in early detection and treatment of chlamydia (CT) and HIV. A yearlong Quality Improvement Project (QIP) (September 2012 – September 2013) brought together four geographically dispersed facilities to focus on improving CT and HIV screening and systems outcomes among American Indian/Alaska Native (AI/AN) serving organizations. 

Methods:  Projects assessed local administrative, staffing, clinical, and data strengths and weaknesses that influence screening. Sites implemented processes to effectively engage community and leadership; develop and sustain a successful and healthy workforce; improve standard delivery of evidence-based quality care; and optimize clinical information systems to drive improvement.

Results:  Preliminary data demonstrated improvement in screening at all participating facilities.  The rate of change varied across sites.  Among eligible clients, screening for HIV ever increased between 8 to 381%; screening for HIV in the past year increased 47 to 270%; and screening for chlamydia improved between 9 to 467%.  Factors influencing screening outcomes at individual sites included historical screening practices (% screened in the past), the size of the health system and the level of care (primary - tertiary care).

Conclusions:  Improvement cannot rely entirely on knowing you need to improve, other factors that predict improvement are ensuring a mechanism for feedback, developing tests of change, and making change part of the system. This project demonstrates how improvement can be facilitated by focusing on the experience of engagement and adoption. An environment of improvement, increased knowledge and awareness, practice- and systems-based change, and patient-centered care helped to advance local improvement efforts. Sites engaged in development of change concepts and owned their respective successes (or failures). By emphasizing the importance of clinical measures, the use of clinical reminders and local data feedback sites were able to inform, evaluate, and drive quality improvement in service delivery and care.