Engagement of Small to Medium-Sized Primary Care Practices in Quality Improvement Efforts

J Am Board Fam Med. 2021 Jan-Feb;34(1):40-48. doi: 10.3122/jabfm.2021.01.200153.


Background: Engaging primary care practices in quality improvement (QI) efforts has been challenging. Literature provides little guidance on the engagement of small to medium-sized practices in QI. This study examined the association between practice readiness and practice characteristics and engagement during a targeted QI effort.

Methods: The study analyzed cross-sectional data collected by the Heart of Virginia Health care, a cardiovascular disease QI intervention study with 195 practices. Data sources include 1) coach-assessed practice engagement in 7 domains (outcome), 2) surveys of readiness completed by 2529 clinicians and staff, a response rate of 86%, and 3) surveys of practice characteristics completed by a physician leader or practice manager. We used descriptive statistics and ordered logit regression for the analysis.

Results: Associations between readiness and engagement were statistically significant for clinician engagement (odds ratio [OR] = 5,74; 95% CI, 1.79-18.42; P = .003) and leadership engagement (OR = 3.19; 95% CI, 1.10-9.24; P = .032). Adjusting for covariates, being a hospital-owned practice was associated with a lower level of clinician engagement (OR = 0.35; 95% CI, 0.16-0.76; P = .009) relative to independent practices.

Discussion: Our study highlights the importance of clinician and leadership engagement as drivers of practice readiness to change in a QI effort. Lack of clinician engagement in hospital-owned practices could be driven by other factors such as burnout that need to be explored in future studies.

Conclusions: Clinicians and leadership involvement in QI efforts is critical. The findings suggest that QI plans should involve clinicians and leaders early in the process to foster commitment, establish practice readiness, and sustain improvement efforts.

Keywords: Cross-Sectional Studies; Leadership; Primary Health Care; Quality Improvement; Surveys and Questionnaires; Virginia.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cross-Sectional Studies
  • Delivery of Health Care
  • Humans
  • Leadership
  • Primary Health Care*
  • Quality Improvement*