RT Journal Article SR Electronic T1 The Alarming Rate of Major Disruptive Events in Primary Care Practices in Oklahoma JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP S52 OP S57 DO 10.1370/afm.2201 VO 16 IS Suppl 1 A1 James W. Mold A1 Margaret Walsh A1 Ann F. Chou A1 Juell B. Homco YR 2018 UL http://www.annfammed.org/content/16/Suppl_1/S52.abstract AB PURPOSE In primary care practices, sustainability of performance improvements and ability to deliver continuity of care to patients can be adversely affected by major disruptive events, such as relocations and changes in ownership, clinicians, and key staff. This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma.METHODS Practices were included if they had existed for 1 year before enrollment and remained in the project for at least 1 year after enrollment. Practice characteristics for 208 practices and major disruptive events during the preenrollment year were collected by survey. Postenrollment major disruptive events were prospectively collected by practice facilitators. We compiled frequency statistics and conducted bivariate analyses for each data set.RESULTS Of 208 eligible practices, 81 (39%) were clinician owned, and 51 (25%) were health system owned. One hundred nine practices (52%) were in nonmetropolitan counties. One hundred seventy-five major disruptive events occurred in 120 (58%) practices during the preenrollment year, with 42 practices having experienced multiple events. During the first year of the project, 89 major disruptive events occurred in 67 (32%) practices, with 20 practices experiencing multiple events. The major disruptive events reported most often during both periods were loss of personnel and implementation of electronic health records and billing systems. Practice size was associated with occurrence of these events.CONCLUSIONS During a 2-year period, major disruptive events occurred at an alarming rate, adversely affecting quality improvement efforts. Most reported events involved losses of clinicians and staff. More research is needed to identify and address the root causes of these events.