The following is a summary of “Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment,” published in the November 2023 issue of Primary Care by Goldberg, et al.

For the EvidenceNOW: Advancing Heart Health in Primary Care initiative, researchers sought to support US primary care practices in implementing evidence-based practices for cardiovascular care and enhancing quality improvement capacity. The study, registered as EvidenceNOW , sought a comprehensive understanding of perspectives from research participants and team members to assess the value of implementation strategies and influencing factors in the Virginia context.

In 2018, 25 focus groups were conducted involving 80 clinicians and staff from participant practices, and face-to-face and telephone interviews were conducted with 22 research team members. Participants included physicians, advanced practice clinicians, practice managers, and other staff. The integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework guided the qualitative data analysis, revealing themes related to the implementation process.

Key implementation strategies valued by both practice representatives and research team members included kick-off events, on-site practice facilitation, and interactions with physician expert consultants. However, utilizing remote practice facilitation and web-based tools was rare. Contextual factors influencing quality improvement efforts encompassed leadership support, resource accessibility, prior quality improvement experiences, and the practice’s ownership type (independent versus health system-owned). Many clinicians and staff faced overwhelming daily activities and initiative fatigue, impeding full participation in the EvidenceNOW initiative.

The study underscored the critical role of the practice environment in implementing evidence-based practices in primary care. Future endeavors to enhance quality in primary care practices should tailor implementation strategies to the unique contexts of individual practices, considering factors such as ownership type. Addressing initiative fatigue among clinicians and staff is crucial, necessitating targeted strategies. External support for building quality improvement capacity could facilitate the sustainable implementation of evidence-based practices and overall quality improvement in primary care.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02200-8