ReviewAnnals of family medicine
Improving medical practice: a conceptual framework.
Review in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 69 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Implementing Tobacco Use Treatment Guidelines in Dental Public Health Clinics
CT Dose Optimization and Standardization Endeavor (DOSE) Collaboratory
Who cites it
69 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments.Implementation science : IS · 2013Pooled it
- Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments.Implementation science : IS · 2012Pooled it
- A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care.Annals of family medicine · 2019Trial
- Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC.Implementation science : IS · 2016Trial
- Long-Term Clinical Outcomes from a Randomized Controlled Trial of Two Implementation Strategies to Promote Collaborative Care Attendance in Community Practices.Administration and policy in mental health · 2015Trial
- MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial.Implementation science : IS · 2014Trial
- Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.Pediatrics · 2014Trial
- Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings.Implementation science : IS · 2014Trial
- Trial
- Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW).Journal of the American Board of Family Medicine : JABFMTrial
- Improving the Adoption of Advance Directives in Primary Care Practices.Journal of the American Board of Family Medicine : JABFMTrial
- Appreciative Inquiry for quality improvement in primary care practices.Quality management in health careTrial
- Implementation outcomes included in NIDA Clinical Trials Network (CTN) studies: A systematic review of studies conducted over 20 years.Journal of substance use and addiction treatment · 2025Article
- Palliative Care Clinicians' Views on Metrics for Successful Specialist Palliative Care Delivery in the ICU.Journal of pain and symptom management · 2024Article
- Guiding Post-Hospital Recovery by 'What Matters:' Implementation of Patient Priorities Identification in a VA Community Living Center.Geriatrics (Basel, Switzerland) · 2023Article
- An Assessment of Weight Loss Management in Health System Primary Care Practices.Journal of the American Board of Family Medicine : JABFM · 2023Article
- Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices.Journal of the American Board of Family Medicine : JABFM · 2022Article
- Strategies for Dose Optimization: Views From Health Care Systems.Journal of the American College of Radiology : JACR · 2022Article
- Healthcare Quality Improvement: The Need for a Macro-Systems Approach.Annual IEEE Systems Conference. IEEE Systems Conference · 2022Article
- Factors associated with successful implementation of telehealth abortion in 4 United States clinical practice settings.Contraception · 2021Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of this article is to produce a relatively simple conceptual framework for guiding and studying practice improvement.
methodsI summarize the lessons from my experience with a variety of quality improvement research studies during the last 30 years, supplemented with relevant literature from both medicine and other industries about the issues associated with successful quality improvement.
resultsMy experience suggests that organizational leadership with an urgent vision for change, ability to manage the change process, and selection of systematic changes capable of fulfilling the vision are each critical for successful quality improvement. Published literature from other industries emphasizes the importance of a goal-directed change process managed by leaders who recognize the need to engage their employees and other leaders in a disciplined but flexible way that accommodates external and internal factors and uses teams and group learning. It also suggests the importance of organizational context and the level of external and internal barriers and facilitators for change. The resulting model proposes that priority, change process, and care process content are necessary for measurable improvements in quality of care and patient outcomes, although internal and external barriers must also be attended to and addressed.
conclusionThis framework may provide a guide to those in the front lines of care who would like to make the care transformations that are needed to greatly improve care. It may also be helpful to those who are developing or testing interventions and recruiting medical practices for such change efforts.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.