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

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.