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Research ArticleOriginal Research

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 and Theresa L. Walunas
The Annals of Family Medicine September 2023, 21 (5) 388-394; DOI: https://doi.org/10.1370/afm.3007
Megan McHugh
1Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
PhD
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  • For correspondence: Megan-mchugh@northwestern.edu
Jennifer Heinrich
2Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
MPH
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Sarah Philbin
3Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
MPH
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Dawn Bishop
4Altarum, Ann Arbor, Michigan
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Justin D. Smith
5Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
PhD
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Jacqueline M. Knapke
6University of Cincinnati, Cincinnati, Ohio
PhD
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Anya Day
4Altarum, Ann Arbor, Michigan
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Theresa L. Walunas
2Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
PhD
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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.
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The Annals of Family Medicine: 21 (5)
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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
The Annals of Family Medicine Sep 2023, 21 (5) 388-394; DOI: 10.1370/afm.3007

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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
The Annals of Family Medicine Sep 2023, 21 (5) 388-394; DOI: 10.1370/afm.3007
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Subjects

  • Methods:
    • Qualitative methods
  • Other research types:
    • PBRN research
  • Other topics:
    • Quality improvement
    • Research capacity building

Keywords

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

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