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

Megan McHugh; Jennifer Heinrich; Sarah Philbin; Dawn Bishop; Justin D. Smith; Jacqueline M. Knapke; Anya Day; Theresa L. Walunas

doi:10.1370/afm.3007

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RE: Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study
Andrew M Ghastine, Kylee E Hamilton, Grace J Park and Lorraine S Wallace

Published on: 27 February 2024
RE: Declining Participation in Primary Care Quality Improvement Research
Michael L Parchman

Published on: 27 September 2023

Published on: (27 February 2024)
Page navigation anchor for RE: Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study
RE: Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study
Andrew M Ghastine, Undergraduate Student, The Ohio State University
Other Contributors:
Kylee E Hamilton, Undergraduate Student

Grace J Park, Undergraduate Student

Lorraine S Wallace, Associate Professor—College of Medicine
It is widely recognized that there is a growing shortage of primary care providers in the
US, and it comes as no surprise that understaffing and time constraints affect primary care
practice quality improvement (QI) study participation. Primary care physicians do not have
adequate time in their day to deviate from patient care. The authors aptly emphasize the great
need for high-level policy interventions to address primary care physician shortages. Further
research should explore how effective scholarship programs like the National Health Service
Corps are at mitigating the primary care workforce shortage and how these efforts can be
scaled up. Another area of interest is medical schools, particularly their primary care pipeline
programs. While these programs may appeal to students hoping to graduate sooner or
minimize cost, it may also be argued that they attract and select students who would have
chosen primary care specialties anyways. Examining the efficacy of primary care pipeline
programs is an important step in addressing the shortage and preventing burnout.
In the meantime, QI projects can offer valuable insight into how to reduce provider
burnout and improve practice efficiency in the face of dramatic understaffing. To do this,
however, project design needs to adjust to the current state of the field. The studies the
authors address offer small financial incentives and likel...
Show More

It is widely recognized that there is a growing shortage of primary care providers in the
US, and it comes as no surprise that understaffing and time constraints affect primary care
practice quality improvement (QI) study participation. Primary care physicians do not have
adequate time in their day to deviate from patient care. The authors aptly emphasize the great
need for high-level policy interventions to address primary care physician shortages. Further
research should explore how effective scholarship programs like the National Health Service
Corps are at mitigating the primary care workforce shortage and how these efforts can be
scaled up. Another area of interest is medical schools, particularly their primary care pipeline
programs. While these programs may appeal to students hoping to graduate sooner or
minimize cost, it may also be argued that they attract and select students who would have
chosen primary care specialties anyways. Examining the efficacy of primary care pipeline
programs is an important step in addressing the shortage and preventing burnout.
In the meantime, QI projects can offer valuable insight into how to reduce provider
burnout and improve practice efficiency in the face of dramatic understaffing. To do this,
however, project design needs to adjust to the current state of the field. The studies the
authors address offer small financial incentives and likely undersell the time commitment—to
incentivize participation, project designers may need to reevaluate the structure of their
studies. The authors point to a few suggestions worth investigating, such as embedding
dedicated project staff within participating practices or redistributing project responsibilities
among practice employees to reduce the burden on clinicians. Given how many respondents
believed that the QI project had no novel information to offer them, we also wonder if practices
would be more inclined to participate if they generated the topics of the studies. Regardless of
the approach, we believe that further research should focus extensively on QI project design if
we hope to alleviate the overwhelming burden on primary care providers.
Show Less

Competing Interests: None declared.
Published on: (27 September 2023)
Page navigation anchor for RE: Declining Participation in Primary Care Quality Improvement Research
RE: Declining Participation in Primary Care Quality Improvement Research
Michael L Parchman, Family Medicine, None
The authors are to be highly commended for undertaking this important work. As a former AHRQ EvidenceNOW Principal Investigator, the findings are consistent with the experiences of our team. Three observations about this work. First, these findings also have implications for those planning to conduct embedded pragmatic clinical trials. It may be difficult to recruit health care settings for these trials for many of the same reasons articulated in this study. Second, in addition to participation, among those who make an initial commitment, many may find that they cannot follow through with participating in the project for many of the same reasons: lack of time, staff turnover, etc. resulting in significant attrition. Finally, interpreting quality improvement study findings is difficult in light of both this attrition, not to mention the inability of the primary care clinic to reliably implement the improvement changes supported by the study protocol due to these same factors. One approach might be to develop better measures of "quality improvement capacity" within the participating clinics, one that is sensitive to change over time and that might be used as a covariate or mediator in analyzing results and interpreting findings.

Competing Interests: None declared.