title: How eight primary care practices initiated and maintained quality monitoring and reporting.
abstract: BACKGROUND
  Primary care medical practices increasingly are asked by payers, employers, and government agencies to report quality data, but the process of doing so is not well delineated.
  
  
  METHODS
  Providers and office staff in a diverse sample of eight primary care practices in North Carolina comprised this study population. Interviews were conducted and self-administered questionnaires were disseminated in practices that were successfully reporting data to one or more of 4 reporting programs. Our measures included responses to open-ended and Likert scale questions about experiences and potential facilitators and barriers, as well as subscales of the Practice Assessment tool and the Culture of Group Practices instrument.
  
  
  RESULTS
  Study practices had stronger change histories, higher information and quality emphases, and lower business emphases than historical comparison practices. Motivation to participate, a leader who catalyzes the process, and establishment of new systems characterized successful practices. Staff time, information technology challenges, and resistance from some providers were common barriers. Practices achieve a sustainability state when numerous barriers have been successfully overcome and tangible results achieved from the process.
  
  
  CONCLUSIONS
  Implementing and sustaining quality reporting requires a complex set of motivators, facilitators, and strategies to overcome inherent barriers that can present themselves in practices that seek to implement changes in this direction.
authors: Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599-7595, USA. psloane@med.unc.edu
authors: Philip D
authors: PD
authors: Sloane
authors: Thomas
authors: T
authors: Wroth
authors: Jacquie
authors: J
authors: Halladay
authors: Paul
authors: P
authors: Bray
authors: Lynn
authors: L
authors: Spragens
authors: Sally
authors: S
authors: Stearns
authors: Sheryl
authors: S
authors: Zimmerman
mesh_terms: D006801:Humans; D009042:Motivation; D009657:North Carolina; D015279:Organizational Culture; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D012107:Research Design; D057566:Self Report