Little is known about what determines strategy implementation around quality improvement (QI) in small and medium-sized primary care practices. New research led by George Mason University's College of Health and Human Services found that independent, physician-owned practices, adopted more QI strategies than hospital-owned practices and community clinics.
Dr. Tulay Soylu, currently assistant professor of instruction at Temple University, led the study published in the Journal of General Internal Medicine in collaboration with George Mason faculty for her dissertation in Mason's Health Services Research PhD Program. The study was a component of a larger practice-level intervention, Heart of Virginia Healthcare, which provided technical assistance to primary care practices in Virginia to improve cardiovascular care. An observational study design surveyed 175 small and medium-sized primary care practices in Virginia to examine how practice characteristics (such as location, size, ownership, and whether they were part of accountable care organizations) and practice readiness to change affected quality improvement (QI) efforts.
The study found that independent, physician-owned practices adopted more changes than hospital-owned practices and community clinics. "The independent practices focused more on patient care coordination (such as developing a care plan and managing medication) rather than organizational improvement strategies (such as optimizing teams or workflow,)" explains Soylu. Community clinics appear to need additional time to implement QI activities, as they face greater financial challenges and often serve sicker patients.
"Adopting evidence-based QI strategies should be part of transforming primary care so practice can track population health, enhance patient experiences and outcomes, reduce costs, and improve provider experience," explains Soylu. "A strong foundation of primary care is essential for the US healthcare system and the COVID-19 pandemic has underscore this need," explains Soylu.
This study provides empirical evidence to primary care practices and policymakers, which highlights the importance of the strategy implementation variation by practice characteristics. QI authorities should consider these characteristics before designing a QI intervention.
Funding was provided for this study by The Agency for Healthcare Research and Quality (R18: HS023913 - PI Dr. Kuzel at Virginia Commonwealth University) and a George Mason University Provost 2019 Dissertation Completion Grant.
About George Mason University
George Mason University is Virginia's largest and most diverse public research university. Located near Washington, D.C., Mason enrolls 38,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity and commitment to accessibility. For more information, visit https://www2.gmu.edu/.
About the College of Health and Human Services
George Mason University's College of Health and Human Services prepares students to become leaders and shape the public's health through academic excellence, research of consequence, community outreach, and interprofessional clinical practice. George Mason is the fastest-growing Research I institution in the country. The College enrolls 2,260 undergraduate and 1,645 graduate students in its nationally-recognized offerings, including: 5 undergraduate degrees, 13 graduate degrees, and 7 certificate programs. For more information, visit https://chhs.gmu.edu/.
Journal of General Internal Medicine