A practice change model for quality improvement in primary care practice

Deborah Cohen, Reuben R. McDaniel, Benjamin F. Crabtree, Mary C. Ruhe, Sharon M. Weyer, Alfred Tallia, William L. Miller, Meredith A. Goodwin, Paul Nutting, Leif I. Solberg, Stephen J. Zyzanski, Carlos R. Jaén, Valerie Gilchrist, Kurt C. Stange

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

Faced with a rapidly changing healthcare environment, primary care practices often have to change how they practice medicine. Yet change is difficult, and the process by which practice improvement can be understood and facilitated has not been well elucidated. Therefore, we developed a model of practice change using data from a quality improvement intervention that was successful in creating a sustainable practice improvement. A multidisciplinary team evaluated data from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized clinical trial conducted to improve the delivery of evidence-based preventive services in 79 northeastern Ohio practices. The team conducted comparative case-study analyses of high- and low-improvement practices to identify variables that are critical to the change process and to create a conceptual model for the change. The model depicts the critical elements for understanding and guiding practice change and emphasizes the importance of these elements' evolving interrelationships. These elements are (1) motivation of key stakeholders to achieve the target for change; (2) instrumental, personal, and interactive resources for change; (3) motivators outside the practice, including the larger healthcare environment and community; and (4) opportunities for change-that is, how key stakeholders understand the change options. Change is influenced by the complex interaction of factors inside and outside the practice. Interventions that are based on understanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice.

Original languageEnglish (US)
Pages (from-to)155-168
Number of pages14
JournalJournal of Healthcare Management
Volume49
Issue number3
StatePublished - May 2004
Externally publishedYes

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Quality Improvement
Primary Health Care
Delivery of Health Care
Randomized Controlled Trials
Medicine
Primary care
Quality improvement
stakeholder
Data Accuracy
medicine

ASJC Scopus subject areas

  • Health(social science)
  • Health Professions(all)

Cite this

Cohen, D., McDaniel, R. R., Crabtree, B. F., Ruhe, M. C., Weyer, S. M., Tallia, A., ... Stange, K. C. (2004). A practice change model for quality improvement in primary care practice. Journal of Healthcare Management, 49(3), 155-168.

A practice change model for quality improvement in primary care practice. / Cohen, Deborah; McDaniel, Reuben R.; Crabtree, Benjamin F.; Ruhe, Mary C.; Weyer, Sharon M.; Tallia, Alfred; Miller, William L.; Goodwin, Meredith A.; Nutting, Paul; Solberg, Leif I.; Zyzanski, Stephen J.; Jaén, Carlos R.; Gilchrist, Valerie; Stange, Kurt C.

In: Journal of Healthcare Management, Vol. 49, No. 3, 05.2004, p. 155-168.

Research output: Contribution to journalArticle

Cohen, D, McDaniel, RR, Crabtree, BF, Ruhe, MC, Weyer, SM, Tallia, A, Miller, WL, Goodwin, MA, Nutting, P, Solberg, LI, Zyzanski, SJ, Jaén, CR, Gilchrist, V & Stange, KC 2004, 'A practice change model for quality improvement in primary care practice', Journal of Healthcare Management, vol. 49, no. 3, pp. 155-168.
Cohen D, McDaniel RR, Crabtree BF, Ruhe MC, Weyer SM, Tallia A et al. A practice change model for quality improvement in primary care practice. Journal of Healthcare Management. 2004 May;49(3):155-168.
Cohen, Deborah ; McDaniel, Reuben R. ; Crabtree, Benjamin F. ; Ruhe, Mary C. ; Weyer, Sharon M. ; Tallia, Alfred ; Miller, William L. ; Goodwin, Meredith A. ; Nutting, Paul ; Solberg, Leif I. ; Zyzanski, Stephen J. ; Jaén, Carlos R. ; Gilchrist, Valerie ; Stange, Kurt C. / A practice change model for quality improvement in primary care practice. In: Journal of Healthcare Management. 2004 ; Vol. 49, No. 3. pp. 155-168.
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