Article Figures & Data
Figures
- Figure 1
Number of practices by total number of major disruptive events.
Tables
Characteristic No. (%) Location Metropolitan 99 (48) Nonmetropolitan 109 (52) Ownership and practice type Clinician owned Traditional private practice 76 (37) Rural health clinic 5 (2) Other private 8 (4) Hospital or health system Traditional private practice 49 (24) Rural health clinics 2 (1) Other corporate 1 (<1) Federally qualified community health center Traditional 36 (17) Indian Health Servicesa 2 (1) Rural health clinic 1 (<1) American Indian practice Indian Health Services 2 (1) Tribal practices 10 (5) Other federal practiceb 7 (3) Other rural health clinics 4 (2) Academic practice 4 (2) Health maintenance organization 1 (<1) Employer-based practice 1 (<1) Foundation-owned free clinic 1 (<1) Nonfederal government practice 1 (<1) Size (number of clinicians) 1 62 (30) 2–5 109 (52) 6–10 26 (12) ≥11c 11 (5) Specialty composition Single specialty 146 (70) Multispecialty 62 (30) ↵a Two practices identified as both tribal federally qualified health centers and Indian Health Services tribal practices.
↵b One practice identified as both a federal clinic and an Indian Health Services tribal practice.
↵c Nine multispecialty practices and 2 academic practices with part-time clinicians (faculty and residents).
Event Practices Affected, No. (%) No. of Unique Practices With MDEs Preenrollment Postenrollment Lost 1 or more clinicians 59 (28) 33 (16) 79 Lost 1 or more office managers or head nurses 38 (18) 14 (7) 51 Moved to a new location 9 (4) 8 (4) 17 Purchased by or affiliated with a larger organization 1 (<1) 4 (2) 5 Implemented a new EHR 33 (16) 15 (7) 43 New billing system 35 (17) 15 (7) 42 Total unique practices with major disruptive events 120 (58)a 67 (32)b 137 EHR = electronic health record; MDE = major disruptive event.
Note: Data on preenrollment MDEs were collected via surveys of practice managers and staff who reported retrospectively on MDEs that occurred within 1 year before study enrollment. Postenrollment data on MDEs were obtained prospectively through reports entered by practice facilitators as they observed workflow in assigned practices. In all, 120 unique practices experienced at least 1 MDE during preenrollment, and 67 unique practices reported at least 1 MDE postenrollment. During the 2-year period, 137 unique practices of the sample of 208 had at least 1 disruptive event.
↵a Forty-two practices experienced more than 1 MDE during the preenrollment period.
↵b Twenty practices experienced more than 1 MDEs during the postenrollment period.
Supplemental Appendix
Supplemental Appendix
Files in this Data Supplement:
- Supplemental Appendix - PDF file
Annals Journal Club
Suppl 1, Apr 2018: Disruption is the Norm
The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article and click on "TRACK Discussion/ Submit a comment.") Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
Mold JW, Walsh M, Chou AF, Homco JB. The alarming rate of major disruptive events in primary care practices in Oklahoma. Ann Fam Med. 2018;16(Suppl 1):S52-S57.
Discussion Tips
There is something in the human psyche that craves constancy and resists change. We tend to treat the calm patches in the sea of life as the norm. We plan for these stable periods and treat disruptions as inconvenient waystations. The article featured as the Annals Journal Club for this supplement shows that the rough waves of change are at least as usual as the glassy surface of stability, with possible implications for practices' ability to engage in quality improvement.
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question?
- To what degree can the findings be accounted for by:
- How patients were selected, excluded, or lost to follow-up?
- How the main variables were measured?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
- Chance?
- How the findings were interpreted?
- What are the main study findings?
- What do you make of the (non-linear) association of disruption with practice size?
- What is your judgment about the transportability of the findings?
- What state and national contextual factors are important for interpreting the findings?
- What do you think of the authors' assertion that these disruptions affect practices' capacity to implement or and continue quality improvement activities?
- How might this study change your practice? Policy? Education? Research?
- Who the constituencies are for the findings, and how they might be engaged in interpreting or using the findings?
- What are the next steps in interpreting or applying the findings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/content/4/3/196.full.
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- What AHRQ Learned While Working to Transform Primary Care
- The Effects of Major Disruptions on Practice Participation in Facilitation During a Primary Care Quality Improvement Initiative
- A Sustainable Model for Preventive Services in Rural Counties: The Healthier Together Study
- A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care
- The Capacity of Primary Care for Improving Evidence-Based Care: Early Findings From AHRQs EvidenceNOW
- Disruption is the Norm