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International Journal for Quality in Health Care Advance Access originally published online on April 24, 2009
International Journal for Quality in Health Care 2009 21(4):225-232; doi:10.1093/intqhc/mzp019
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© The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results

Giovanni Filardo1, David Nicewander1, Jeph Herrin2, Janine Edwards3, Percy Galimbertti3, Mari Tietze4, Susan Mcbride4, Julie Gunderson1, Ashley Collinsworth1, Ziad Haydar1, Josie Williams3 and David J. Ballard1

1 Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75206, USA
2 Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
3 Texas A&M University Health Science Center, 3833 Texas Avenue, Suite 150, Bryan, TX 77802, USA
4 Dallas Fort Worth Hospital Council, 250 Decker Drive, Irving, TX 75062, USA

Objective. To investigate the effectiveness of a quality improvement educational program in rural hospitals.

Design. Hospital-randomized controlled trial.

Setting/Participants. A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool.

Intervention. The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves.

Main Outcome Measures. Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program.

Results. No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group.

Conclusions. While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

Keywords: quality improvement/quality management, quality indicators/measurement of quality, rural or urban/specific populations, hospital care, setting of care, training/education, human resources

Address reprint requests to: David J. Ballard, Institute for Health Care Research and Improvement, 8080 N. Central Expressway, Suite 500, Dallas, TX 75206, USA. Tel: 214-265-3670; Fax: 214-265-3640; E-mail: dj.ballard{at}baylorhealth.edu

Accepted for publication March 27, 2009.


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