Does Quality Improvement Work? Evaluation of the Organ Donation Breakthrough Collaborative

OBJECTIVE: The Organ Donation Breakthrough Collaborative is a quality improvement initiative to encourage adoption of "best practices" for identifying potential donors and obtaining consent for deceased organ donation. We evaluate the impact of the first phase on organ donation rates. SETTING: We study donation rates in the 95 hospitals that participated in the first phase and a control group of 125 hospitals. DESIGN: We use a controlled pre/post design. The preperiod is the year before the start of the Collaborative (September 2002 to August 2003), the postperiod is the final 6 months of the first phase (March 2004 to August 2004). DATA: We use administrative data from the Organ Procurement and Transplantation Network to compute the conversion rate in each hospital group and time period. The conversion rate is the proportion of eligible donors who became actual donors. PRINCIPAL FINDINGS: Preperiod conversion rates in Collaborative and control hospitals were similar: 52 and 51 percent, respectively. In the postperiod, the conversion rate increased to 60 percent among Collaborative hospitals and remained at 51 percent among control hospitals. The relative change was 8 percentage points (95 percent confidence interval: 2-13: p<.001). CONCLUSIONS: Our findings suggest that the Breakthrough Collaborative led to an increase in donation rates at participating hospitals.