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Contextual Factors Associated With Quality Improvement Success in a Multisite Ambulatory Setting

Douglas, Lindsey C.; Heo, Moonseong; Azad, Namita; Racine, Andrew D.; Rinke, Michael L.

The Journal for Healthcare Quality (JHQ): September/October 2019 - Volume 41 - Issue 5 - p 317–328
doi: 10.1097/JHQ.0000000000000186
Original Article

ABSTRACT The Model for Understanding Success in Quality (MUSIQ) is a framework of contextual factors for quality improvement (QI) projects. We sought to determine which MUSIQ contextual factors were associated with successful QI initiatives. In a cross-sectional survey study, at a 21-site, ambulatory, urban primary care network, a modified MUSIQ survey tool questionnaire was administered to QI team members. The primary analysis associated objective measures of QI success with MUSIQ contextual factors. Objective QI success was defined as reaching goal percentages of adult patients with diabetes achieving glycated hemoglobin less than 8% and/or pediatric patients who had received combination toddler vaccines. Objective outcomes were compared with a subjective, self-reported outcome measure of QI success because previous literature found subjective outcomes were associated with specific MUSIQ factors. In the 143 survey responses collected, across 21 sites, no contextual factors from the MUSIQ survey were associated with either the adult or pediatric objective measure of QI project success. In a post hoc analysis, objective and subjective measures of success were often not associated and/or negatively correlated. In conclusion, contextual factors were not associated with objective measures of QI outcomes, in contrast to previous studies finding associations with subjective QI outcome measures.

For more information on this article, contact Lindsey C. Douglas at,

Funders: M. L. Rinke and M. Heo were supported by the Agency for Healthcare Research and Quality (HS0203608-01).

The authors declare no conflicts of interest.

© 2019 National Association for Healthcare Quality
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