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Using a Virtual Breakthrough Series Collaborative to Improve Access in Primary Care

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Background: The Institute for Healthcare Improvement (IHI) pioneered the Breakthrough Series (BTS), a short-term improvement project that convenes, in three face-to-face meetings, hospital or clinic teams to make rapid, significant improvement. A distance-learning (virtual) version of the BTS—a VBTS—was conducted.

Methods: A model VBTS was tested with 20 organizations, using a well-established topic: improving access and efficiency in primary care. This VBTS took place by Internet and telephone, using Web-based collaboration software and audioconferencing.

Results: For the 17 organizations completing the VBTS, the average number of days to third-next-available appointment fell from 23 to 10 days (July 2004–June 2005). The Improvement Assessment Scale showed 59% of teams at level 4 or above ("significant" improvement, with most changes implemented, and evidence of sustained improvement in outcomes and plans for spread). Potential direct cost savings were about $12,000 as compared with a traditional collaborative. Six months after the VBTS's conclusion, 70% of the teams that achieved significant improvement either maintained gains or improved their results.

Discussion: Outcomes in a VBTS are potentially comparable to those in a traditional collaborative, at substantially lower cost. Prerequisites for success include senior leadership's involvement, team members' ability to participate, and information technology support.

Document Type: Research Article

Publication date: October 1, 2006

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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