Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Ann Fam Med. 2018 Apr;16(Suppl 1):S52-S57. doi: 10.1370/afm.2201.
In primary care practices, sustainability of performance improvements and ability to deliver continuity of care to patients can be adversely affected by major disruptive events, such as relocations and changes in ownership, clinicians, and key staff. This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma.
Practices were included if they had existed for 1 year before enrollment and remained in the project for at least 1 year after enrollment. Practice characteristics for 208 practices and major disruptive events during the preenrollment year were collected by survey. Postenrollment major disruptive events were prospectively collected by practice facilitators. We compiled frequency statistics and conducted bivariate analyses for each data set.
Of 208 eligible practices, 81 (39%) were clinician owned, and 51 (25%) were health system owned. One hundred nine practices (52%) were in nonmetropolitan counties. One hundred seventy-five major disruptive events occurred in 120 (58%) practices during the preenrollment year, with 42 practices having experienced multiple events. During the first year of the project, 89 major disruptive events occurred in 67 (32%) practices, with 20 practices experiencing multiple events. The major disruptive events reported most often during both periods were loss of personnel and implementation of electronic health records and billing systems. Practice size was associated with occurrence of these events.
During a 2-year period, major disruptive events occurred at an alarming rate, adversely affecting quality improvement efforts. Most reported events involved losses of clinicians and staff. More research is needed to identify and address the root causes of these events.
在初级保健实践中，重大破坏性事件（如搬迁、所有权变更、临床医生和关键员工的变更）可能会对绩效的持续改进和为患者提供连续护理的能力产生不利影响。本研究记录了俄克拉荷马州一组初级保健实践中的重大破坏性事件的发生率。
如果实践在入组前已经存在 1 年，并且在入组后至少 1 年内仍在项目中，则将其纳入研究。通过调查收集了 208 个实践的特征和入组前一年的重大破坏性事件。通过实践促进者前瞻性收集了入组后重大破坏性事件。我们为每个数据集编制了频率统计数据并进行了双变量分析。
在 208 个符合条件的实践中，81 个（39%）由临床医生拥有，51 个（25%）由卫生系统拥有。109 个实践（52%）位于非城市县。在入组前一年，120 个实践（58%）发生了 175 次重大破坏性事件，其中 42 个实践发生了多次事件。在项目的第一年，67 个实践（32%）发生了 89 次重大破坏性事件，其中 20 个实践发生了多次事件。在这两个时期报告最多的重大破坏性事件是人员流失以及电子健康记录和计费系统的实施。实践规模与这些事件的发生有关。
在两年期间，重大破坏性事件以惊人的速度发生，对质量改进工作产生了不利影响。大多数报告的事件涉及临床医生和员工的流失。需要进一步研究以确定和解决这些事件的根本原因。
