Evidence map›Paper›PMID 32779136›Full record

Observational studyJournal of general internal medicine2020

Readiness and Implementation of Quality Improvement Strategies Among Small- and Medium-Sized Primary Care Practices: an Observational Study.

Tulay G Soylu, Alison E Cuellar, Debora G Goldberg, Anton J Kuzel

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Tulay G SoyluDepartment of Health Administration and Policy, George Mason University, Fairfax, VA, USA. tsoylu@gmu.edu.ORCID http://orcid.org/0000-0003-2620-766X
Alison E CuellarDepartment of Health Administration and Policy, George Mason University, Fairfax, VA, USA.
Debora G GoldbergDepartment of Health Administration and Policy, George Mason University, Fairfax, VA, USA.
Anton J KuzelFamily Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA.

Funding

Restoring Primary Care in Virginia: PCOR Learning as a Pathway to ValueR18HS023913 · AHRQ · VIRGINIA COMMONWEALTH UNIVERSITY · PI KUZEL, ANTON J · 2015 to 2017
$9.4M
AHRQ HHS R18 HS023913AHRQ HHS R18: HS023913
6 · The paper itself

Abstract

backgroundLittle is known about what determines strategy implementation around quality improvement (QI) in small- and medium-sized practices. Key questions are whether QI strategies are associated with practice readiness and practice characteristics.

objectiveGrounded in organizational readiness theory, we examined how readiness and practice characteristics affect QI strategy implementation. The study was a component of a larger practice-level intervention, Heart of Virginia Healthcare, which sought to transform primary care while improving cardiovascular care.

designThis observational study analyzed practice correlates of QI strategy implementation in primary care at 3 and 12 months. Data were derived from surveys completed by clinicians and staff and from assessments by practice coaches.

participantsA total of 175 small- and medium-sized primary care practices were included. MAIN MEASURES: Outcome was QI strategy implementation in three domains: (1) aspirin, blood pressure, cholesterol, and smoking cessation (ABCS); (2) care coordination; and (3) organizational-level improvement. Coaches assessed implementation at 3 and 12 months. Readiness was measured by baseline member surveys, 1831 responses from 175 practices, a response rate of 73%. Practice survey assessed practice characteristics, a response rate of 93%. We used multivariate regression. KEY

resultsQI strategy implementation increased from 3 to 12 months: the mean for ABCS from 1.20 to 1.59, care coordination from 2.15 to 2.75, organizational improvement from 1.37 to 1.78 (95% CI). There was no statistically significant association between readiness and QI strategy implementation across domains. Independent practice implementation was statistically significantly higher than hospital-owned practices at 3 months for ABCS (95% CI, P = 0.01) and care coordination (95% CI, P = 0.03), and at 12 months for care coordination (95% CI, P = 0.04).

conclusionQI strategy implementation varies by practice ownership. Independent practices focus on patient care-related activities. FQHCs may need additional time to adopt and implement QI activities. Practice readiness may require more structural and organizational changes before starting a QI effort.

Indexed as

Primary Health CareQuality ImprovementDelivery of Health CareHumansOrganizational InnovationVirginiahospital-owned practiceindependent practiceorganizational readinessprimary carequality improvementstrategic activitystrategy implementation

Identifiers

PMID32779136
PMCPMC7573036

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Registered trials

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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.