Patient Safety and Quality

Lack of resources and time, along with staff burnout, are barriers to sustaining quality improvement in community health centers

For a quality improvement (QI) intervention to be successful over the long term, dedicated staff time must be available for QI leadership, data entry, and management of a related patient registry, a new study reports. The study is based on surveys of community health center leaders and staff participating in the ongoing Health Disparities Collaboratives, a national effort to improve quality of care for chronic diseases.

Based on responses to a survey, the researchers found that team leaders spent nearly 11 hours per week (27 percent of work time) solely on activities tied to the collaboratives. Team members spent nearly 8 hours (19 percent of their time), chief executive officers spent nearly 3 hours (6 percent of their time), and physicians spent nearly 5 hours (10 percent of their time). Nearly all (91 percent) of the health centers designated personnel to spend at least some of their time on data entry for the collaboratives, 80 percent for using registry data to determine patient needs and 85 percent for leading QI interventions. In 20 percent of the centers, staff did these tasks on an unpaid basis, without having them part of their regular job descriptions. Only 24 percent indicated that there was sufficient funding and 31 percent that there were sufficient personnel resources to run the collaboratives.

The study was based on receipt of 1,006 surveys from 153 community health centers. Respondents included nurses (27 percent of surveys) and physicians (16 percent). Nurse practitioners and physician assistants provided 2.5 percent and 4.7 percent of the responses, respectively. The study was funded in part by the Agency for Healthcare Research and Quality (HS13635 and HS10479).

More details are in "Sustaining quality improvement in community health centers. Perceptions of leaders and staff," by Marshall H. Chin, M.D., M.P.H., Anne C. Kirchhoff, M.P.H., Amy E. Schlotthauer, M.P.H., and others, in the October-December 2008 Journal of Ambulatory Care Management 31(4), pp. 319-329.

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