Adapting IHI model for Community-Based Outcome Improvements: The Case of Texas Healthcare Transformation and Quality Improvement Program

“Breakthrough Series” is a collaborative learning by using an IHI model, aiming to achieve breakthrough improvements in quality while reducing costs.  Starting from 1995 when the learning collaborative framework was created, IHI has sponsored over 50 collaborative projects, more than 2000 teams from 1000 health care organizations.  The present study introduces the IHI model and demonstrates the successful application in the former clinical projects, and demonstrates how this framework has been adopted in Harris Health learning collaborative.

In December 2011, Texas received federal approval of an 1115 waiver that would preserve Upper Payment Limit (UPL) funding under a new methodology, but allow for managed care expansion to additional areas of the state.  To meet the 1115 waiver requirement, the Harris Health System has adopted the IHI learning collaborative model to inform the participating region and to facilitate shared learning and improvement across projects, and to improve community outcome through cohort subgroups sharing knowledge and expertise. 

The study illustrates the implementation process of IHI model in Harris Health.  The learning collaborative cohorts include EC utilization cohort, navigation cohort, behavioral health cohort, primary & specialty care access cohort, and chronic care cohort; the functional groups include quality improvement (QI) group, data group, and leader liaison.  The study examines how the learning collaborative is structured, how the personnel coordinate and communicate within and across cohort groups.

Moreover, the study discusses the applicability of the IHI framework for Harris Health learning collaborative given the differences between the traditional IHI model application and the Harris Health initiative projects.  The traditional IHI model has been mostly applied to the clinical improvements for a single project. On the contrary, the Harris Health learning collaborative involves 161 projects and 27 performing providers. All providers are invited to participate in learning sessions and collaborate based on topics of interest.