Examining Perceptions of Participation in a Pediatric IBD Collaborative: Analyzing the Integral Features and Activities of ImproveCareNow

In 2007, pediatric gastroenterologists from ten practice sites across the U.S. created a quality improvement collaborative, now known as ImproveCareNow, to improve the quality of care provided to children with inflammatory bowel disease. Despite the face validity and great potential of quality improvement collaboratives, investigators do not fully understand how improvement happens, including the variables contributing to quality measures and the necessary components needed to sustain quality improvement. The purpose of this project was to explore perceptions of collaborative participants to identify elements of sustainability. We performed qualitative interviews with 16 ImproveCareNow participants as one method in a triangulated strategy of measuring collaborative participants’ perceptions. We selected informants from a diverse list of practice types and geographic locations, and asked open-ended questions, which we then transcribed and coded. For this master’s paper, I analyzed members’ perceptions of value of, and implementation strategies for, collaborative components like previsit planning, patient databases (population management), standardized clinic forms and algorithms, and decision support. I found that collaborative participants value many system-wide features of collaborative participation, but sites have different paths to implementation, and important features are underdeveloped or under-utilized at some sites. Respondents embraced the potential of population management reports, but noted that data entry burdened clinic flow. Previsit planning was cited as moderately successful, and one site had developed a novel modification of the planning to obviate face-to-face meetings. Standardized clinic templates and decision analysis tools met high expectations for mutual benefit from individual innovation and ingenuity. Analyzing in-depth interviews of ICN participants is the first step in understanding what health care providers perceive as the value from, benefits of, and challenges to initiating and sustaining collaborative quality improvement activities Perspective (Author’s Note) This master’s paper represents a component of a larger team project that allowed my friend and colleague Erica Peterson and I to utilize qualitative research tools to examine a pediatric IBD quality improvement collaborative. Working together, we were able to assess the perspectives of collaborative participants and explore the literature surrounding quality improvement collaboratives in greater depth than possible had there been just one of us. Therefore, the work completed for the master’s paper and practicum requirements was a collaborative effort itself, in which we both contributed equally at every stage. Although our master’s project examined the perceptions of participation in a pediatric IBD collaborative, I focused on the practice variation and implementation of key ICN activities, while Erica chose to focus on elements of sustainability of particular ICN activities and the Improve Care Now (ICN) collaborative itself. We hope to present our combined work to the ICN Research Committee in the fall, at which time we will present data from a web-based survey that we constructed. A complete discussion of the derivation and analysis of the survey results, as well as conclusions drawn from collected data, are largely beyond the scope of this project. Still, the in-depth interviews we conducted with health care providers were very engrossing, and allowed us to observe and analyze perspectives of individuals with varying interests and roles in quality improvement. Overall, sustaining quality improvement requires systems change and commitment at all levels of the health care system.