Factors Influencing Quality Improvement Success in Primary Care: A Comparative Case Study of High- and Low-Performing Sites in Patient Hypertension Outcomes.

backgroundApproximately 50% of adults with hypertension have their blood pressure under control. Although the success of quality improvement (QI) initiatives aiming to improve blood pressure control varies across clinics, little is known about factors related to this variability. We conducted a mixed-methods comparative case study to describe the factors that affected clinics' QI success within a statewide cardiovascular health collaborative.

methodsForty-eight primary care clinics (caring for 357 158 patients) implemented QI for heart health. Using blood pressure control improvement rates from pre- to postimplementation, practice type, and location, we selected 8 sites for our case comparison. We then conducted site observations and interviews with team members at the high-performing sites (hypertension improved 11.7%-15.2% among 1364 patients) and low-performing sites (hypertension worsened -1.8% to -11.2% among 3614 patients).

resultsKey facilitators shared by all sites included QI coaching, data monitoring, regular team meetings, use of program resources, and commitment to QI. Key barriers shared by both high- and low-performing sites included staff challenges, internal barriers, and competing priorities. Notably, although thematic similarities were found across all sites, differences in performance emerged in how the sites responded: either proactively or reactively.

conclusionsThis study examined differences in implementation between high- and low-performing practices that participated in a statewide QI initiative. Results highlight the importance of proactive approaches to addressing barriers to achieve improvements in blood pressure control. Findings can inform future QI work in primary care, underscoring the need for tailored strategies to promote effective implementation and better outcomes.