title: Different paths to high-quality care: three archetypes of top-performing practice sites.
abstract: OBJECTIVE
  Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes.
  
  
  METHODS
  This study used an observational case study design. A practice-level measure of adherence to clinical guidelines was used to identify the highest performing practices in a network of internal and family medicine practices participating in a national demonstration project. We analyzed qualitative and quantitative information derived from project documents, field notes, and evaluation questionnaires to develop and compare case studies.
  
  
  RESULTS
  Nine cases are described. All use many of the same improvement strategies. Differences in the way improvements are organized define 3 distinct archetypes: the Technophiles, the Motivated Team, and the Care Enterprise. There is no single approach that explains the superior performance of high-performing practices, though each has adopted variations of PPRNet's improvement model.
  
  
  CONCLUSIONS
  Practices will vary in their path to high-quality care. The archetypes could prove to be a useful guide to other practices selecting an overall quality improvement approach.
authors.affiliation: Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif 90033, USA. feifer@usc.edu
authors.forename: Chris
authors.initials: C
authors.lastname: Feifer
authors.forename: Lynne
authors.initials: L
authors.lastname: Nemeth
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Wessell
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: Loraine
authors.initials: L
authors.lastname: Roylance
authors.forename: Steven M
authors.initials: SM
authors.lastname: Ornstein
mesh_terms: D000328:Adult; D005194:Family Practice / Q000458:organization & administration*; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D019370:Observation; D017410:Practice Guidelines as Topic; D011216:Practice Management, Medical / Q000145:classification* / Q000458:organization & administration*; D019984:Quality Indicators, Health Care