From Community-Based Pilot Testing to Region-Wide Systems Change

BACKGROUND: A community-based collaborative conducted a 2-year pilot study to inform efforts for improving maternal and child health care practice and policy in Allegheny County, Pennsylvania. OBJECTIVES: (1) To test whether three small-scale versions of an evidence-based, systems improvement approach would be workable in local community settings and (2) to identify specific policy/infrastructure reforms for sustaining improvements. METHODS: A mixed methods approach was used, including quantitative performance measurement supplemented with qualitative data about factors related to outcomes of interest, as well as key stakeholder interviews and a literature review/Internet search. RESULTS: Quantitative performance results varied; qualitative data revealed critical factors for the success and failure of the practices tested. Policy/infrastructure recommendations were developed to address specific practice barriers. This information was important for designing a region-wide quality improvement initiative focused on maternal depression. CONCLUSION: The processes and outcomes provide valuable insights for other communities interested in conducting similar quality improvement initiatives.