Using a virtual breakthrough series collaborative to improve access in primary care

Jt Comm J Qual Patient Saf. 2006 Oct;32(10):573-84. doi: 10.1016/s1553-7250(06)32075-2.


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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Appointments and Schedules*
  • Cost Savings
  • Education, Distance*
  • Health Services Accessibility / organization & administration*
  • Humans
  • Inservice Training / methods
  • Internet*
  • Models, Organizational
  • Organizational Innovation
  • Primary Health Care / economics
  • Primary Health Care / statistics & numerical data*
  • Quality Assurance, Health Care / methods
  • User-Computer Interface