RT Journal Article
SR Electronic
T1 Facilitators of Transforming Primary Care: A Look Under the Hood at Practice Leadership
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP S27
OP S33
DO 10.1370/afm.1492
VO 11
IS Suppl 1
A1 Donahue, Katrina E.
A1 Halladay, Jacqueline R.
A1 Wise, Alison
A1 Reiter, Kristin
A1 Lee, Shoou-Yih Daniel
A1 Ward, Kimberly
A1 Mitchell, Madeline
A1 Qaqish, Bahjat
YR 2013
UL http://www.annfammed.org/content/11/Suppl_1/S27.abstract
AB PURPOSE This study examined how characteristics of practice leadership affect the change process in a statewide initiative to improve the quality of diabetes and asthma care. METHODS We used a mixed methods approach, involving analyses of existing quality improvement data on 76 practices with at least 1 year of participation and focus groups with clinicians and staff in a 12-practice subsample. Existing data included monthly diabetes or asthma measures (clinical measures) and monthly practice implementation, leadership, and practice engagement scores rated by an external practice coach. RESULTS Of the 76 practices, 51 focused on diabetes and 25 on asthma. In aggregate, 50% to 78% made improvements within in each clinical measure in the first year. The odds of making practice changes were greater for practices with higher leadership scores (odds ratios = 2.41–4.20). Among practices focused on diabetes, those with higher leadership scores had higher odds of performing nephropathy screening (odds ratio = 1.37, 95% CI, 1.08–1.74); no significant associations were seen for the intermediate outcome measures of hemoglobin A1c, blood pressure, and cholesterol. Focus groups revealed the importance of a leader, typically a physician, who believed in the transformation work (ie, a visionary leader) and promoted practice engagement through education and cross-training. Practices with greater change implementation also mentioned the importance of a midlevel operational leader who helped to create and sustain practice changes. This person communicated and interacted well with, and was respected by both clinicians and staff. CONCLUSIONS In the presence of a vision for transformation, operational leaders within practices can facilitate practice changes that are associated with clinical improvement.