Redesigning the system from the bottom up: lessons learned from a decade of federal quality improvement collaboratives.

The Health Resources and Services Administration (HRSA) is a federal agency that provides support and resources for America's safety-net providers. For more than 10 years, HRSA has engaged in Quality Improvement Breakthrough Collaboratives that have brought together multiple stakeholders to improve quality of care and enhance patient outcomes for the most vulnerable populations. Many of these collaboratives followed the Institute for Healthcare Improvement's Breakthrough Series Collaborative model and methodology to implement small tests of change that helped generate process improvements and clinical outcomes. This commentary summarizes HRSA's experience with these Quality Improvement Breakthrough Collaboratives, focusing on key lessons learned, in order to help inform and enhance future quality improvement efforts in both the public and the private sectors.

Geographic proximity of HRSA, VA, and DOD clinics: opportunities for interagency collaboration to improve quality.

Clinics funded by the Department of Veterans Affairs (VA), Department of Defense's Military Health System (MHS), and Department of Health and Human Services' Health Resources and Services Administration (HRSA) all play a role in serving the military, veterans, and their families. Publicly available location data on federal health care clinics was merged, analyzed, and geographically overlaid using GIS. Results showed that 20% of U.S. counties contain both HRSA and VA sites, and 5% contain HRSA and MHS facilities. Additionally, 80% of VA and 76% of MHS clinics are within 10 miles of a HRSA clinic. Specific clinic types of interest also overlay; for instance, 90% of HRSA homeless clinics are in the same county as a VA facility. This demonstrated geographic proximity of health care sites may indicate prime opportunities for collaboration between HRSA, VA, and MHS systems to improve quality of care for the military, veterans, and their families.

Implementing colorectal cancer screening in community health centers: addressing cancer health disparities through a regional cancer collaborative.

BACKGROUND: The population served by Federally Qualified Health Centers (FQHCs) has lower levels of cancer screening compared with the general population and suffers a disproportionate cancer burden. To address these disparities, 3 federal agencies and a primary care association established and tested the feasibility of a Regional Cancer Collaborative (RCC) in 2005. METHODS: RCC faculty implemented a learning model to improve cancer screening across 4 FQHCs that met explicit organizational readiness criteria. Regional faculty trained "care process leaders," who worked with primary care teams to plan and implement practice changes. FQHCs monitored progress across the following measures of screening implementation: self-management goal-setting; number and percent screened for breast, cervical, and colorectal cancer; percent timely results notification; and percent abnormal screens evaluated within 90 days. Progress and plans were reviewed in regular teleconferences. FQHCs were encouraged to create local communities of practice (LCOP) involving community resources to support cancer screening and to participate in a monthly teleconference that linked the LCOPs into a regional community of practice. Summary reports and administrative data facilitated a process evaluation of the RCC. chi test and test of trends compared baseline and follow-up screening rates. RESULTS: The RCC taught the collaborative process using process leader training, teleconferences, 2 regional meetings, and local process improvement efforts. All organizations created clinical tracking capabilities and 3 of the 4 established LCOPs, which met monthly in an regional community of practice. Screening documentation increased for all 3 cancers from 2005 to 2007. Colorectal cancer screening increased from 8.6% to 21.2%. CONCLUSIONS: A regional plan to enable collaborative learning for cancer screening implementation is feasible, and improvements in screening rates can occur among carefully selected organizations.