Department of Health Policy, Center for Healthcare Quality, George Washington University, Washington, DC 20037, USA.
Health Serv Res. 2013 Apr;48(2 Pt 1):398-416. doi: 10.1111/1475-6773.12000. Epub 2012 Oct 4.
To understand what motivates primary care practices to engage in practice improvement, identify external and internal facilitators and barriers, and refine a conceptual framework.
In-depth interviews and structured telephone surveys with clinicians and practice staff (n = 51), observations, and document reviews.
Comparative case study of primary care practices (n = 8) to examine aspects of the practice and environment that influence engagement in improvement activities.
Three on-site visits, telephone interviews, and two surveys.
Pressures from multiple sources create conflicting forces on primary care practices' improvement efforts. Pressures include incentives and requirements, organizational relationships, and access to resources. Culture, leadership priorities, values set by the physician(s), and other factors influence whether primary care practices engage in improvement efforts.
Most primary care practices are caught in a cross fire between two groups of pressures: a set of forces that push practices to remain with the status quo, the "15-minute per patient" approach, and another set of forces that press for major transformations. Our study illuminates the elements involved in the decision to stay with the status quo or to engage in practice improvement efforts needed for transformation.
了解促使基层医疗实践进行实践改进的动机，确定外部和内部的促进因素和障碍，并完善一个概念框架。
对临床医生和实践工作人员（n = 51）进行深入访谈和结构化电话调查、观察和文件审查。
对基层医疗实践（n = 8）进行比较案例研究，以研究影响参与改进活动的实践和环境方面。
三次现场访问、电话访谈和两次调查。
来自多个来源的压力对基层医疗实践的改进努力产生了冲突的力量。压力包括激励和要求、组织关系以及获取资源的机会。文化、领导重点、医生设定的价值观以及其他因素影响基层医疗实践是否进行改进努力。
大多数基层医疗实践都陷入了两组压力之间的拉锯战：一组力量促使实践保持现状，即“每位患者 15 分钟”的方法，另一组力量则推动重大变革。我们的研究阐明了决定保持现状或参与变革所需的实践改进努力的相关因素。
