Dataset Information

Why do some primary care practices engage in practice improvement efforts whereas others do not?

ABSTRACT:

Objective

To understand what motivates primary care practices to engage in practice improvement, identify external and internal facilitators and barriers, and refine a conceptual framework.

Data sources

In-depth interviews and structured telephone surveys with clinicians and practice staff (n = 51), observations, and document reviews.

Study design

Comparative case study of primary care practices (n = 8) to examine aspects of the practice and environment that influence engagement in improvement activities.

Data collection methods

Three on-site visits, telephone interviews, and two surveys.

Principal findings

Pressures from multiple sources create conflicting forces on primary care practices' improvement efforts. Pressures include incentives and requirements, organizational relationships, and access to resources. Culture, leadership priorities, values set by the physician(s), and other factors influence whether primary care practices engage in improvement efforts.

Conclusions

Most primary care practices are caught in a cross fire between two groups of pressures: a set of forces that push practices to remain with the status quo, the "15-minute per patient" approach, and another set of forces that press for major transformations. Our study illuminates the elements involved in the decision to stay with the status quo or to engage in practice improvement efforts needed for transformation.

SUBMITTER: Goldberg DG

PROVIDER: S-EPMC3626340 | biostudies-literature | 2013 Apr

REPOSITORIES: biostudies-literature

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Publications

Why do some primary care practices engage in practice improvement efforts whereas others do not?

Goldberg Debora Goetz DG Mick Stephen S SS Kuzel Anton J AJ Feng Lisa Bo LB Love Linda E LE

Health services research 20121004 2 Pt 1

<h4>Objective</h4>To understand what motivates primary care practices to engage in practice improvement, identify external and internal facilitators and barriers, and refine a conceptual framework.<h4>Data sources</h4>In-depth interviews and structured telephone surveys with clinicians and practice staff (n = 51), observations, and document reviews.<h4>Study design</h4>Comparative case study of primary care practices (n = 8) to examine aspects of the practice and environment that influence engag ...[more]

PMID: 23034072

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Project description:BackgroundEfforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes.ObjectiveTo examine practice contextual features that moderate intervention effectiveness.DesignSecondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care.ParticipantsForty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment.Main measuresThe primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos).Key resultsAcross the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p < .001), -.75(p = .004)); Medicaid: < 20 % vs. ≥ 20 % (-.20(p = .48), +.75 (p = .08), +.60(p = .02)); practice size: < 4 clinicians vs. ≥ 4 clinicians (+.56(p = .02), +1.96(p < .001), +.02(p = .91)); practice Change Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p < .001), +.67(p = .005)) and variability in practice Change Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm.ConclusionsThis study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.

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Dataset Information

Why do some primary care practices engage in practice improvement efforts whereas others do not?

Objective

Data sources

Study design

Data collection methods

Principal findings

Conclusions

Publications

Why do some primary care practices engage in practice improvement efforts whereas others do not?

Similar Datasets

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