The Alarming Rate of Major Disruptive Events in Primary Care Practices in Oklahoma

Abstract

During a 2-year period, major disruptive events occurred at an alarming rate, adversely affecting quality improvement efforts. Most reported events involved losses of clinicians and staff. More research is needed to identify and address the root causes of these events.

Fidelity Evaluation of the Compared Procedures for Conducting the PREDIAPS Implementation Strategy to Optimize Diabetes Prevention in Primary Care

“…Additionally, the exposure indicators suggest that professionals assigned to execute the strategy through sequential engagement of colleagues (starting with nurses who later sought the engagement of the physicians) had an unexpectedly higher degree of exposure to the implementation strategy actions, particularly in the case of nurses, the staff responsible for providing the active element of the clinical intervention. As described in the literature, commonly reported obstacles faced by physicians to fully engaging in implementation actions included heavy workload, staff turnover, di culties in investing time and effort improvement initiatives beyond providing care, and existing practice priorities [28][29][30].…”

“…In any case, differential participation or exposure to the strategy could compromise the future implementation of the clinical intervention that we are seeking to promote [31]. Therefore, future analysis and interpretation of the main outcomes of interest should be adjusted for the degree of participation of professionals in general and/or exposure to the actions of the implementation strategy as a function of study arm and professional group [11,30].…”

“…With respect to the planned implementation strategy [20], it proved unfeasible to carry out some activities, for example, the total number of planned monitoring and ongoing facilitation sessions. As commented previously, di culty in scheduling meetings due to work overload or other competing priorities are common barriers faced by facilitators in improvement initiatives [30,33]. There was demand among professionals for additional actions related to speci c core strategies within the overall implementation strategy like training actions regarding the clinical intervention.…”

A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care

“…In addition, many enrolled practices experienced a considerable disruption such as the departure of a clinician or office manager during the study, similar to findings from other EvidenceNOW collaboratives. 19 Finally, it is worth noting that we were unable to provide any financial incentives or payments to the enrolled practices for participating in the study, limiting their ability to devote resources to study-related activities.…”

“…18 Major disruptions such as clinician and staff turnover or changes in health information technology systems are common. 19 In addition, these practices struggle with generating the performance reports needed to guide QI activities. 20 Many have proposed providing external support to overcome these challenges and assist these practices in making changes required to improve care quality.…”