ArticleAnnals of family medicine
Using Learning Teams for Reflective Adaptation (ULTRA): insights from a team-based change management strategy in primary care.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol.BMC cancer · 2018Trial
- Periodic reflections: a method of guided discussions for documenting implementation phenomena.BMC medical research methodology · 2018Trial
- Supporting Practices to Adopt Registry-Based Care (SPARC): protocol for a randomized controlled trial.Implementation science : IS · 2015Trial
- Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial.Journal of general internal medicine · 2015Trial
- Meeting the challenge of practice quality improvement: a study of seven family medicine residency training practices.Academic medicine : journal of the Association of American Medical Colleges · 2011Trial
- Practice facilitation to improve diabetes care in primary care: a report from the EPIC randomized clinical trial.Annals of family medicineTrial
- Effects of facilitated team meetings and learning collaboratives on colorectal cancer screening rates in primary care practices: a cluster randomized trial.Annals of family medicineTrial
- Typical electronic health record use in primary care practices and the quality of diabetes care.Annals of family medicineTrial
- How team-based reflection affects quality improvement implementation: a qualitative study.Quality management in health careTrial
- Team-based care in small primary care practices: a scoping review.BMC health services research · 2026Article
- Article
- Adapting and implementing breast cancer follow-up in primary care: protocol for a mixed methods hybrid type 1 effectiveness-implementation cluster randomized study.BMC primary care · 2023Article
- Team-based home blood pressure monitoring for blood pressure equity a protocol for a stepped wedge cluster randomized trial.Contemporary clinical trials · 2023Article
- Developing the EQUIPED approach to quality management using multi-grounded theory.Nutrition & dietetics : the journal of the Dietitians Association of Australia · 2023Article
- At the edge of chaos: a prospective multiple case study in Australian general practices adapting to COVID-19.BMJ open · 2023Article
- Utilizing PRISM and RE-AIM to implement and evaluate the Rural Telementoring Training Center (RTTC) for health care workforce development in rural communities.Frontiers in health services · 2023Article
- How do general practices respond to a pandemic? Protocol for a prospective qualitative study of six Australian practices.BMJ open · 2021Article
- Implementation of Community-Based Resource Referrals for Cardiovascular Disease Self-Management.Annals of family medicine · 2020Article
- Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study.BMC health services research · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
purposeThe Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed.
methodsWe analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach.
resultsDespite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practice-wide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines.
conclusionPrimary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.
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