Article Figures & Data
Tables
Characteristic QI Projects Focused on Unhealthy Alcohol Use QI Projects Focused on Heart Health INSPIRE Project MI-SPARC Project HH4M Project HHOI Project Targeted states Wisconsin, Illinois Michigan, Indiana Michigan Ohio Recruitment period February 2020-March 2020; September 2020-April 2022 February 2021-September 2022 October 2021-August 2022 April 2021-May 2022 Approximate time commitment for practices 1 hour per week over 6 months 2-hour initial training; 1-2 hours per month over 6 months 1-2 hours per month over 12 months 4-hour initial training; quarterly 1-hour webinars; 1 hour per month over 12 months Compensation per practice, $ None ≤2,500 1,000 4,000 HH4M = Healthy Hearts for Michigan; HHOI = Heart Healthy Ohio Initiative; INSPIRE = Intervention in Small Primary Care Practices to Implement Reduction in Unhealthy Alcohol Use; MI-SPARC = Michigan Sustained Patient-Centered Alcohol-Related Care; QI = quality improvement.
Note: Enrollment rates ranged from approximately 2% to 6% across the 4 projects. Precise rates are unknown because some recruiters used listservs (eg, local medical societies) and the number of practices reached through those channels was estimated. Further, the number of ineligible practices among nonrespondents was unknown.
Practices QI Projects Focused on Unhealthy Alcohol Use QI Projects Focused on Heart Health Total INSPIRE Project MI-SPARC Project HH4M Project HHOI Project Contacted, No. 24 35 39 11 109 Responded, No. (%)a 9 (37.4) 7 (20.0) 8 (20.5) 7 (63.6) 31 (28.4) Completed interview, No. 3 3 3 7 16 Completed questionnaire, No. 2 1 0 0 3 Sent e-mail response, No. 4 3 5 0 12 HH4M = Healthy Hearts for Michigan; HHOI = Heart Healthy Ohio Initiative; INSPIRE = Intervention in Small Primary Care Practices to Implement Reduction in Unhealthy Alcohol Use; MI-SPARC = Michigan Sustained Patient-Centered Alcohol-Related Care; QI = quality improvement.
↵a The percentage is the participation rate for this follow-up study.
- Table 3.
Key Themes and Representative Quotes on Reasons for Declining Participation in an Evidence-Based QI Project
Theme Representative Quotes Staffing shortages; difficulty just maintaining usual operations (primary theme) “Our staff is not the same either, they’re not the same performers that they were pre-COVID. We’re all seeing that, as I talked to my colleagues around the country.”
“We are definitely short staffed, and if it required any amount of doing extra, that would have been put on my plate, and I have no extra to give.”
“It’s been increasingly difficult to keep staff, everybody seems to be short staffed. We can’t seem to find enough people to work and people that are reliable.”
“COVID has really put a lot of challenges on our health centers from a staffing perspective…no one’s back to where they need to be to pay the bills. I sit in lots of venues where that’s the conversation, and to be able to give people the time they need for these types of initiatives, to do it well and to embrace what is intended, is what we’re all struggling with.”Clinicians’ and staff’s lack of time to engage in additional activities (primary theme) “I already take home too much work, which ends up getting done late at night or early in the morning. There are many days when I feel like I’m barely keeping my head above water. This wouldn’t have been a healthy addition.” Concern that QI project’s time requirement, although reasonable, would be more than stated (primary theme) “The 1 hour a month or 1 hour a quarter is not that much. It’s not too much. It’s everything in between. Right? It’s the, ‘We’re making a plan, now we want to implement it, now we need to talk about how to do that. Bring in staff. We need to follow up on the action plan and track everything and do the PDSAs.’ That’s where the time commitment is.” Confidence in practice’s current ability to care for patient group targeted by QI project (secondary theme) “[The QI project] mirrored the processes that we already have in place, so we were already screening for substance use and utilizing the SBIRT process at our medical sites. It felt like it was an additional screening we were already doing and an additional process that we kind of felt like we were already doing on top of the fact that we are kind of underwater with too much stuff to do.” Ongoing changes to EHR; concern that EHR lacked capability to extract necessary performance data (secondary theme) “Our biggest barrier at the time was our transition from one electronic medical record to another. And at that time, we weren’t sure how to pull data from that new system. We didn’t know what access we would have to the data or how we could customize reporting or anything.”
“We didn’t have the capacity to pull the data in the way they wanted it to be. So we have a lot of pretty sophisticated data functionality. But it was still not what we had the ability to do without going back to our Epic team, and our Epic team is not super keen on building reports, and so that was something that we decided was not going to be beneficial for us.”Expectation of compensation for participation in QI projects that take time away from direct patient care (secondary theme) “Right in the middle of all this, I lost my key person that helps manage this data and submit a lot of those data for the programs. Truthfully, my bandwidth was strapped and I think there was $4,000 incentive to get us to do this. It would cost me more than that to do it.” EHR = electronic health record; PDSA = plan-do-study-act; QI = quality improvement; SBIRT = screening, brief intervention, and referral to treatment.
- Table 4.
Key Themes and Representative Quotes on Recommendations for Improving the Feasibility or Attractiveness of QI Projects
Theme Representative Quotes External QI projects are not well situated to address the staffing and time deficiencies within primary care practices (primary theme) “It’s not fair for you to think there’s something that you could have done differently.”
“There is not anything that could have changed regarding the program that would have allowed us to participate with the already maxed resources, as serving patients and their needs is our top priority.”There are strategies that QI project planners can use to facilitate the recruitment of primary care practices (secondary theme) “Helping them build the team to do this work. Not counting on the primary care provider being the driver of this bus but wrapping that provider with—is it a care manager, is it a social worker, is it some other care team participant—who can take on some of this work?”
“Maybe tailoring the programs based on regionality or rurality of the organization…having the ability to send people out, coming face to face and actually participating in those meetings and maybe leading some of these meetings that will be meaningful rather than a WebEx.”
“I used to get 15-20 e-mails a day and now get 50 or more a day. But I just delete most of my e-mails. Bang, bang, bang, bang. Maybe sending a formal letter of some kind would get my attention better.”
“It’s always good to hear or talk to someone who’s [already] gone through it.”Compensation may facilitate enrollment in QI projects for some practices; however, for most practices, it would not have made a difference (secondary theme) “I don’t know if I can give you a number right now, but it would really have to be enough to compensate for the amount of time that I was going to put into it as well as our clinical staff and our data team.”
“I don’t know. For us, I don’t think [compensation] would have made any difference at all. That’s not why we were really interested in doing it.”QI = quality improvement.
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