Positive and Negative Spillovers of the Health Disparities Collaboratives in Federally Qualified Health Centers

Quality improvement (QI) interventions are generally evaluated for their intended effects without examining whether they lead to positive or negative spillovers. This study aimed to assess the unintended effects of QI interventions and found that the Health Disparities Collaborative (HDC) intervention has effects beyond what it intended, and that the unintended effects were more positive than negative.

The authors sent a mail survey to 1,256 staff at 135 federally qualified health centers (FQHC) that implemented HDC; they asked about the extent to which HDC has effects beyond those intended, especially on aspects of patient care and FQHC function that HDC does not address. Respondents rated HDC's unintended effects as positive or negative. The authors also conducted 50 semi-structured interviews with HDC and FQHC personnel.

Respondents most often perceived HDC as beneficial to non-HDC patient care and FQHC functioning. Areas in which most respondents perceived improvement included care for chronic conditions that HDC did not target, quality of care for patients with multiple chronic conditions and the ease with which patients moved through FQHCs and FQHCs’ entire QI plans.

The authors recommend including QI initiatives’ unintended effects in evaluations. This study was limited by focusing on respondents’ perceptions of QI's unintended effects, not whether those effects actually occurred.