STUDYING PUBLIC HEALTH QUALITY IMPROVEMENT COLLABORATIVE EVALUATION TO ADVANCE KNOWLEDGE AND IMPROVE IMPLEMENTATION

ABSTRACTEmily C. T. Cimini: Studying Public Health Quality Improvement Collaborative Evaluation to Advance Knowledge and Improve Implementation(Under the direction of Karl Umble)Background and Significance: Quality Improvement Collaboratives (QICs) constitute a popular approach to improving health system performance. QICs have garnered tremendous support from funders and health systems even though evidence is limited regarding whether, how and in what contexts they work. The literature review herein identifies the features of PHQICs that may impact whether, how and in what contexts they work.Research Question and Aims: This dissertation aims to answer the question, “How can Public Health Quality Improvement Collaboratives (PHQIC) be evaluated to fill current knowledge gaps about whether, how and in what contexts they work?” The aims are to: (1) Describe key features of contemporary PHQIC evaluation; (2) Describe PHQIC leaders’ perspectives on current practices to evaluate whether, how and in what contexts PHQICs work: what’s happening, what’s working well, what needs improvement in PHQIC evaluation; and (3) Describe PHQIC leaders’ perspectives on barriers and facilitators to optimizing evaluation of whether, how and in what contexts PHQICs work.Methods: This study used an explanatory, sequential qualitative design: a systematic review of 66 evaluation documents submitted by seven QIC leaders and 20 key informant interviews (KII) with experienced QIC leaders (18 of whom completed a pre-KII questionnaire). Participants’ diverse demographics, training and QIC experience are described. Scissor-and-sort technique was used for qualitative coding. Extensive member checking was completed to ensure that respondents' ideas were represented accurately.Outcomes: Results informed seven recommendations to improve QIC evaluation, including measuring equity, examining psycho-social aspects of QICs and studying participants’ priority questions. Recommendations also include increasing access to evaluation expertise, strengthening and diversifying dissemination, advocating for health informatics improvements and integrating more rigorous evaluation methods.Plan for Change: My plan for change is guided by the Knowledge to Action Framework (KTA). I plan to engage stakeholders in further knowledge inquiry and synthesis, followed by strategic dissemination and execution of recommendations. I propose a QIC on QIC evaluation.Conclusion: This dissertation supports improved QIC evaluation, which will address the many important questions about whether, how and in what contexts QICs work. Ultimately, enhancing the evidence base for QIC implementation should result in improved public health.