Primary Care Practice Transformation is Hard Work

Insights From a 15-year Developmental Program of Research

Dados Bibliográficos

ID9104130
AutoresBenjamin F Crabtree (0000-0003-2292-6835, Johnson University, autor correspondente), Paul A Nutting (University of Colorado Denver), William L Miller (0000-0002-9957-1211, Lehigh Valley Hospital-Pocono), Reuben R Mcdaniel (The University of Texas at Austin), Kurt C Stange (0000-0002-2189-0191, Case Western Reserve University), Carlos Roberto Jaén (0000-0001-5904-4719, The University of Texas at Austin), Elizabeth Stewart (0000-0003-1299-5423, American Academy of Family Physicians, autor correspondente)
Ano2011
Volume49
PáginasS28-S35
Data de publicação2011-12-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181cad65c
PMID20856145
PMCIDPMC3043156
OpenAlexW2062536947
IdiomaEN
Citações recebidas9
Referências citadas28

BACKGROUND: Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. METHODS: Our research team conducted a series of National Institutes of Health funded descriptive and intervention projects to understand organizational change in primary care practice settings, emphasizing a complexity science perspective. The result was a developmental research effort that enabled the identification of critical lessons relevant to enabling practice change. RESULTS: A summary of findings from a 15-year program of research highlights the limitations of viewing primary care practices in the mechanistic terms that underlie current or traditional approaches to quality improvement. A theoretical perspective that views primary care practices as dynamic complex adaptive systems with "agents" who have the capacity to learn, and the freedom to act in unpredictable ways provides a better framework for grounding quality improvement strategies. This framework strongly emphasizes that quality improvement interventions should not only use a complexity systems perspective, but also there is a need for continual reflection, careful tailoring of interventions, and ongoing attention to the quality of interactions among agents in the practice. CONCLUSIONS: It is unlikely that current strategies for quality improvement will be successful in transforming current primary care practice to a patient-centered medical home without a stronger guiding theoretical foundation. Our work suggests that a theoretical framework guided by complexity science can help in the development of quality improvement strategies that will more effectively facilitate practice change

Environmental health · Family medicine · MEDLINE · Political science · Primary care · Primary health care · Transformation (genetics) · Work (physics) · Engineering · Health Policy Implementation Science · Interprofessional Education and Collaboration · Medicine · Primary Care and Health Outcomes