So Far and Yet So Near: Virtual Quality Improvement Networks in Health Care

Membership in the global Indian diaspora comes with a price, and my family and friends use Skype and FaceTime with regularity to bridge distances. It then comes as no surprise that health care is now using similar communication technology to provide better and safer patient care.

A few months ago it was reported that the majority of the 150 hospitals in the
Robert Wood Johnson Foundation’s Aligning Forces for Quality program improved care delivery in 16 communities across the United States through a quality improvement collaborative. The program averted unnecessary hospital readmissions and improved timely emergency care.

The premise of virtual quality improvement networks is that collective brainpower can be effectively harnessed through communication technology. Network participants collaboratively develop and implement quality improvement tools and strategies, and share lessons learnt.

UC Davis has a robust telemedicine program that connects hundreds of rural clinics, mainly providing individual specialty consultations. Since clinics are already outfitted with technology for distance communication, we wanted to see if clinics could use already existing telemedicine equipment for distance education and the creation of a virtual quality improvement learning network.

The Healthy Eating Active Living Community of Practice, or HEALTH-COP, reached out to seven clinics in rural California. Clinics were located in a variety of settings and served diverse populations. For example, one clinic was located on the California-Mexico border and another was near the California-Oregon border. To put this into context, California has 1.7 times the landmass of the United Kingdom and is the eighth largest economy in the world.

Through regular video-conferencing and an online discussion forum, clinics significantly improved weight screening and obesity prevention counseling for children, and change clinic systems to more efficiently deliver care. Three months later, we followed children up again and we found that they had actually improved their diets and increased their physical activity. Not a minor feat, as most parents will testify.

Perhaps the most valuable innovation was the increased connectivity between clinics. Peer support allowed clinicians to share their experiences and knowledge, collectively customize parent education materials, and identify creative ways to improve access for their patients. Clinicians told us that the program reduced their own barriers related to professional isolation and that the most useful aspect was their enhanced ability to think through issues along with colleagues in other rural areas.

Two brains are better than one. And as we found in HEALTH-COP, fifty brains are better than two.

- Ulfat Shaikh