Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study

Ann Fam Med. 2023 Sep-Oct;21(5):388-394. doi: 10.1370/afm.3007.


Purpose: There are numerous supportive quality improvement (QI) projects to facilitate the implementation of evidence-based practices in primary care, but recruiting physician practices to join these projects is challenging, costly, and time consuming. We aimed to identify factors leading primary care practices to decline participation in QI projects, and strategies to improve the feasibility and attractiveness of QI projects in the future.

Methods: For this qualitative study, we contacted 109 representatives of practices that had declined participation in 1 of 4 Agency for Healthcare Research and Quality-funded EvidenceNOW projects. The representatives were invited to participate in a 15-minute interview or complete a 5-question questionnaire. Thematic analysis was used to organize and characterize findings.

Results: Representatives from 31 practices (28.4% of those contacted) responded. Overwhelmingly, respondents indicated that staff turnover, staffing shortages, and general time constraints, exacerbated by the pandemic, prevented participation in the QI projects. Challenges with electronic health records, an expectation of greater financial compensation for participation, and confidence in the practices' current care practices were secondary reasons for declining participation. Tying participation to value-based programs and offering greater compensation were identified as strategies to facilitate recruitment. None of the respondents' recommendations, however, addressed the primary issues of staffing challenges and time constraints.

Conclusions: Staffing challenges and general time constraints, exacerbated by the pandemic, are compromising primary care practices' ability to engage in QI research projects. To encourage participation, policy makers should consider direct supports for primary care, which may also help to alleviate burnout.

Keywords: health workforce; incentives; nonrespondents; organizational change; practice-based research; primary care; qualitative methods: key informant/in-depth interviewing; quality improvement; recruitment; staffing; time.

Publication types

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

MeSH terms

  • Electronic Health Records
  • Evidence-Based Practice*
  • Humans
  • Primary Health Care
  • Qualitative Research
  • Quality Improvement*