Implementation of quality improvement skills by primary care teams: case study of a large academic practice.
BACKGROUND
Continuous quality improvement (QI) is important to primary care in general, and is emphasized as a key tenet of the primary care patient-centered medical home (PCMH) model. While team-based QI activities within the PCMH model are expected, concerns exist as to how successful efforts have been at implementing team-driven QI projects.


OBJECTIVE
To (a) identify opportunities and challenges to QI efforts in a large primary care practice in order to (b) develop action plans to facilitate QI work into primary care teams.


METHODS
We obtained qualitative and quantitative information about existing primary care team QI initiatives.


METHODS
Eleven interdisciplinary primary care teams and 4 facilitators/coaches.


METHODS
We conducted unstructured interviews and gathered documentation from primary care team members about QI efforts to (a) characterize team-based QI progress and (b) identify barriers and facilitators.


RESULTS
In the 18 months since local leadership prioritized conducting team-based QI projects, team members described multiple exposures to QI training, coaching resources, and data/analysis support. No team developed a formal aim statement. Six of the 11 teams completed any steps beyond the initial team discussion. Four teams attempted to apply an intervention. Challenges included team time and competing demands/priorities; 3 of the 4 teams attempting to implement a project credited a data/informatics facilitator for their progress.


CONCLUSIONS
In this large academic primary care clinic setting, interdisciplinary team training in QI, support for data collection, and dedicated coaching resources produced few sustainable continuous QI initiatives. Several potentially modifiable barriers to initiation, completion, and sustainability of QI initiatives by primary care teams were identified.
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.
Brook
B
Watts
Renée H
RH
Lawrence
Simran
S
Singh
Carol
C
Wagner
Sarah
S
Augustine
Mamta K
MK
Singh
D006784:Hospitals, Teaching; D006787:Hospitals, Veterans; D006801:Humans; D009820:Ohio; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*; D011795:Surveys and Questionnaires
patient care team; patient-centered care; primary care; quality improvement