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AHRQ Research Studies Date
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- Primary Care: Models of Care (14)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 38 Research Studies DisplayedSafon CB, Estela MG, Rosenberg J
Implementation of a novel pediatric behavioral health integration initiative.
The purpose of this concurrent, qualitative-dominant mixed methods empirical study was to explore healthcare professionals' perceptions of the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). The researchers utilized semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year process and surveys administered at three time points. Qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. The researchers round five emergent themes aligning with RC domains. The results of the survey showed that healthcare professionals reported both greater behavioral healthcare integration into clinic practice and greater clinic readiness to address behavioral health needs. The researchers concluded that effective pediatric BHI and care delivery at CHCs may depend on solid professional relationships and communication.
AHRQ-funded; HS022242.
Citation: Safon CB, Estela MG, Rosenberg J .
Implementation of a novel pediatric behavioral health integration initiative.
J Behav Health Serv Res 2023 Jan;50(1):1-17. doi: 10.1007/s11414-022-09803-6..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Delivery, Primary Care, Patient-Centered Healthcare, Community-Based Practice
Bierman AS, Tong ST, McNellis RJ
AHRQ Author: Bierman AS, Tong ST, McNellis RJ
Realizing the dream: the future of primary care research.
In this article, the authors discussed the primary care research central to successful primary care transformation and to realizing the vision of a high-performing US health system to serve effectively all Americans and their communities while advancing health equity.
AHRQ-authored.
Citation: Bierman AS, Tong ST, McNellis RJ .
Realizing the dream: the future of primary care research.
Ann Fam Med 2022 Mar-Apr;20(2):170-74. doi: 10.1370/afm.2788..
Keywords: Primary Care, Healthcare Delivery, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Healthcare
Chen H, Upadhyay N, Lyu N
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
This study’s objective was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care agreements (ICAs) following diagnosis for Attention Deficit Hyperactive Disorder (ADHD) or Major Depressive Disorder (MDD) given by primary care providers (PCPs) in the pediatric setting. The ICAs were categorized as PCPs who practiced alone (non-co-located); PCPs practiced with specialist outside the practice but co-located at the practice site; and employed specialists who were co-located. A total of 4203 incident ADHD and 298 incident MDD diagnoses were identified, of which 74% of ADHD cases and 67% of MDD cases received treatment within 90 days of diagnosis. Children with ADHD were twice as likely to receive treatment if they were diagnosed by non-co-located or co-affiliated PCPs than those diagnosed by non-co-located PCPs. Those treated children were also 2 times more likely to receive guideline recommended psychotherapy and treated at the diagnosing site versus elsewhere.
AHRQ-funded; HS025251.
Citation: Chen H, Upadhyay N, Lyu N .
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
Acad Pediatr 2021 Sep-Oct;21(7):1187-94. doi: 10.1016/j.acap.2021.05.021..
Keywords: Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care, Healthcare Delivery, Depression
Quigley DD, Slaughter M, Qureshi N
Practices and changes associated with patient-centered medical home transformation.
Knowing which patient-centered medical home (PCMH) care delivery changes and quality improvement (QI) practices further PCMH implementation is essential. In this study, the investigators used the 2008-2017 National Committee of Quality Assurance (NCQA) PCMH directory of 15,188 primary care practices that received Level 1, 2, or 3 NCQA PCMH recognition to: 1.) construct a stratified national sample of 105 practices engaged in PCMH transformation and 2.) examine their QI practices and PCMH changes associated with PCMH transformation.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Slaughter M, Qureshi N .
Practices and changes associated with patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):386-93. doi: 10.37765/ajmc.2021.88740..
Keywords: Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Quigley DD, Qureshi N, AlMasarweh L
Using CAHPS patient experience data for patient-centered medical home transformation.
The purpose of this study was to examine how primary care practices used the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and its patient-centered medical home (PCMH) items during their PCMH transition. The investigators concluded that CAHPS surveys were considered actionable for PCMH transformation and used in standardizing and coordinating care. The CAHPS PCMH items were considered integral to the continuous QI needed for moving beyond formal PCMH recognition and maximizing transformation.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Qureshi N, AlMasarweh L .
Using CAHPS patient experience data for patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):e322-e29. doi: 10.37765/ajmc.2021.88745..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Grove LR, Gertner AK, Swietek KE
Effect of enhanced primary care for people with serious mental illness on service use and screening.
This retrospective cohort study compared healthcare use and screening receipt of people with serious mental illness (SMI) newly receiving enhanced primary care to people with SMI newly receiving usual primary care. Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and dates, and recommended screenings 18 months after the initial visit. Enhanced primary care was associated with an increase of 1.2 primary care visits in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient days and 3.0 non-psychiatric inpatient days. There was no significant effect on psychiatric service and ED visits. Enhanced primary care increased the probability of preventive screenings such as glucose and HIV, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening.
AHRQ-funded; HS000032.
Citation: Grove LR, Gertner AK, Swietek KE .
Effect of enhanced primary care for people with serious mental illness on service use and screening.
J Gen Intern Med 2021 Apr;36(4):970-77. doi: 10.1007/s11606-020-06429-2..
Keywords: Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Screening, Healthcare Utilization, Healthcare Delivery
Han B, Chen PG, Yu H
Access to after-hours primary care: a key determinant of children's medical home status.
Researchers sought to identify individual survey items or domains that best predict medical home (MH) status for children and use them to develop brief markers of MH status. Using MEPS data, they found that accessibility, especially the ability to access health care after regular office hours, appeared to be the major predictor of having a MH among children. They recommended that the ongoing efforts to promote the MH model target improving accessibility of health care after regular hours for children overall and especially for Latino children.
AHRQ-funded; HS023336.
Citation: Han B, Chen PG, Yu H .
Access to after-hours primary care: a key determinant of children's medical home status.
BMC Health Serv Res 2021 Feb 27;21(1):185. doi: 10.1186/s12913-021-06192-y..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Access to Care, Healthcare Delivery, Disparities, Racial and Ethnic Minorities
Qureshi N, Quigley DD, Hays RD
Nationwide qualitative study of practice leader perspectives on what it takes to transform into a patient-centered medical home.
The purpose of this study was to examine reasons practices obtained and maintained patient-centered medical home (PCMH) recognition and what resources were needed. The investigators concluded that PCMH efforts necessitated support and assistance to frontline, on-site practice leaders leading care delivery changes. They suggested that change efforts should include financial incentives (e.g., direct payment or additional reimbursement), leadership direction and support, and internal or external staff with experience with the PCMH application process, implementation changes, and QI expertise in monitoring process and outcome data.
AHRQ-funded; HS016980.
Citation: Qureshi N, Quigley DD, Hays RD .
Nationwide qualitative study of practice leader perspectives on what it takes to transform into a patient-centered medical home.
J Gen Intern Med 2020 Dec;35(12):3501-09. doi: 10.1007/s11606-020-06052-1..
Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care, Healthcare Delivery
Chan B, Hulen E, Edwards S
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
AHRQ-funded; HS022981.
Citation: Chan B, Hulen E, Edwards S .
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
Ann Fam Med 2019 Nov;17(6):495-501. doi: 10.1370/afm.2464..
Keywords: Primary Care, Primary Care: Models of Care, Ambulatory Care and Surgery, Vulnerable Populations, Patient-Centered Healthcare, Healthcare Delivery
Bierman AS
AHRQ Author: Bierman AS
Preventing and managing multimorbidity by integrating behavioral health and primary care.
People with multimorbidity are especially challenged in navigating fragmented health systems designed to treat diseases rather than people. The harms associated with this fragmentation, such as adverse events resulting from conflicting treatments and increased costs, have been well documented. As a result, there have been renewed calls for more patient-centered care, with a particular emphasis on the importance of the integration of primary care and behavioral health as fundamental for achieving this goal. This paper discusses preventing and managing multimorbidity by integrating behavioral health and primary care.
AHRQ author - Bierman
Citation: Bierman AS .
Preventing and managing multimorbidity by integrating behavioral health and primary care.
Health Psychol 2019 Sep;38(9):851-54. doi: 10.1037/hea0000787..
Keywords: Care Coordination, Healthcare Delivery, Behavioral Health, Patient-Centered Healthcare, Primary Care
Riley AR, Paternostro JK, Walker BL
The impact of behavioral health consultations on medical encounter duration in pediatric primary care: a retrospective match-controlled study.
This retrospective match-controlled study examined the impact of behavioral health consultations on medical visit duration in pediatric primary care. Patient encounters involving behavioral health consultants were significantly longer (11 plus minutes) than matched controls, and had less time allowed for medical care. The authors of the study recommend that behavioral health consultants work with the clinician to improve time efficiency.
AHRQ-funded; HS022981.
Citation: Riley AR, Paternostro JK, Walker BL .
The impact of behavioral health consultations on medical encounter duration in pediatric primary care: a retrospective match-controlled study.
Fam Syst Health 2019 Jun;37(2):162-66. doi: 10.1037/fsh0000406..
Keywords: Behavioral Health, Children/Adolescents, Healthcare Delivery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Primary Care: Models of Care
Riley AR, Freeman KA
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
This commentary discusses the role that behavioral analysts can have in partnership with pediatric medicine. There have been advances, but there has been limited impact for the daily practice of pediatrics. The authors discuss why behavioral pediatrics has failed to gain traction in primary care, describe possible opportunities for an expanded portfolio of research, and identify several examplars from the behavior analytic literature that has influenced pediatric primary care, and make further recommendations for producing influential data.
AHRQ-funded; HS022981.
Citation: Riley AR, Freeman KA .
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
Behav Anal 2019 Feb;19(1):23-38. doi: 10.1037/bar0000114..
Keywords: Behavioral Health, Children/Adolescents, Health Services Research (HSR), Healthcare Delivery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Primary Care: Models of Care, Research Methodologies
Chan B, Edwards ST, Devoe M
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. In this paper, the authors present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.
AHRQ-funded; HS022981.
Citation: Chan B, Edwards ST, Devoe M .
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Addict Sci Clin Pract 2018 Dec 14;13(1):27. doi: 10.1186/s13722-018-0128-y..
Keywords: Primary Care, Healthcare Delivery, Patient-Centered Healthcare, Vulnerable Populations, Chronic Conditions
Fraze TK, Fisher ES, Tomaino MR
Comparison of populations served in hospital service areas with and without comprehensive primary care plus medical homes.
The purpose of this comparative cross sectional study was to describe practices that joined the Comprehensive Primary Care Plus (CPC+) model and compare hospital service areas with and without CPC+ practices. The authors concluded that according to this study, although a diverse set of practices joined the CPC+ program, practices in areas characterized by patient populations with greater advantage were more likely to join, which may affect access to advanced primary care medical home models such as CPC+, by vulnerable populations.
AHRQ-funded; HS024075.
Citation: Fraze TK, Fisher ES, Tomaino MR .
Comparison of populations served in hospital service areas with and without comprehensive primary care plus medical homes.
JAMA Netw Open 2018 Sep 7;1(5):e182169. doi: 10.1001/jamanetworkopen.2018.2169..
Keywords: Primary Care, Patient-Centered Healthcare, Primary Care: Models of Care, Healthcare Delivery, Access to Care
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Howard J, Miller WL, Willard-Grace R
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
The purpose of this study was to learn from the experiences of innovative primary care practices that have successfully developed care teams. The authors assert that team-based care is possible and valuable in primary care but that it is difficult to develop and sustain, and requires dedicated time and resources. They suggest that the challenges described by the highly motivated practices, in their paper, raised the question of feasibility for more average practices in the current funding environment.
AHRQ-funded.
Citation: Howard J, Miller WL, Willard-Grace R .
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
Qual Manag Health Care 2018 Jul/Sep;27(3):123-29. doi: 10.1097/qmh.0000000000000176..
Keywords: Primary Care, Patient-Centered Healthcare, Teams, Healthcare Delivery
Annis AM, Harris M, Kim HM
Trends in primary care encounters across professional roles in PCMH.
Evaluation measures of team-based care models are often reported at a clinic or primary care provider (PCP) level, creating challenges in describing and analyzing the use and impact of non-PCP clinician team members. This study aimed to measure clinician-specific care delivery trends and determine whether trends were responsive to system wide patient centered medical home implementation.
AHRQ-funded;
Citation: Annis AM, Harris M, Kim HM .
Trends in primary care encounters across professional roles in PCMH.
Am J Manag Care 2018 Jul;24(7):e222-e29..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Teams
Chou AF, Homco JB, Nagykaldi Z
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
The Healthy Hearts for Oklahoma (H2O) Study proposes to build a quality improvement (QI) infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; and (2) providing QI support in primary care practices to better manage patients at risk for cardiovascular disease (CVD) events. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) performance. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations.
AHRQ-funded; HS023919.
Citation: Chou AF, Homco JB, Nagykaldi Z .
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
BMC Health Serv Res 2018 Jun 4;18(1):404. doi: 10.1186/s12913-018-3189-4.
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Keywords: Cardiovascular Conditions, Communication, Heart Disease and Health, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Prevention, Quality of Care, Quality Improvement
Halle AD, Mroz TM, Fogelberg DJ
Occupational therapy and primary care: updates and trends.
This paper identifies new initiatives and opportunities in primary care, explores common challenges to integrating occupational therapy in primary care environments, and highlights international works that can support the authors’ efforts.
AHRQ-funded; HS022907.
Citation: Halle AD, Mroz TM, Fogelberg DJ .
Occupational therapy and primary care: updates and trends.
Am J Occup Ther 2018 May/Jun;72(3):7203090010p1-10p6. doi: 10.5014/ajot.2018.723001..
Keywords: Healthcare Delivery, Primary Care, Policy, Patient-Centered Healthcare
Mold JW, Walsh M, Chou AF
The alarming rate of major disruptive events in primary care practices in Oklahoma.
This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma. During the first year of the project, 89 major disruptive events occurred in 67 (32 percent) 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.
AHRQ-funded; HS023919.
Citation: Mold JW, Walsh M, Chou AF .
The alarming rate of major disruptive events in primary care practices in Oklahoma.
Ann Fam Med 2018 Apr;16(Suppl 1):S52-s57. doi: 10.1370/afm.2201.
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Keywords: Electronic Health Records (EHRs), Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Quality Improvement
Ono SS, Crabtree BF, Hemler JR
Taking innovation to scale in primary care practices: the functions of health care extension.
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. This article describes how cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement.
AHRQ-funded; HS023940.
Citation: Ono SS, Crabtree BF, Hemler JR .
Taking innovation to scale in primary care practices: the functions of health care extension.
Health Aff 2018 Feb;37(2):222-30. doi: 10.1377/hlthaff.2017.1100.
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Keywords: Primary Care, Implementation, Cardiovascular Conditions, Evidence-Based Practice, Healthcare Delivery, Practice Improvement, Quality Improvement, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention
Kim LY, Rose DE, Soban LM
Primary care tasks associated with provider burnout: findings from a Veterans Health Administration survey.
The purpose of this study was to investigate (1) the extent to which primary care providers (PCPs) share responsibility for 14 discrete primary care tasks with other team members, and (2) which, if any, of the primary care tasks performed by the PCPs (without reliance on team members) are associated with PCP burnout.
AHRQ-funded; HS000046.
Citation: Kim LY, Rose DE, Soban LM .
Primary care tasks associated with provider burnout: findings from a Veterans Health Administration survey.
J Gen Intern Med 2018 Jan;33(1):50-56. doi: 10.1007/s11606-017-4188-6..
Keywords: Healthcare Delivery, Health Services Research (HSR), Patient-Centered Healthcare, Primary Care, Provider, Workforce
Cottrell EK, Hall JD, Kautz G
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. This study conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations. They identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment.
AHRQ-funded; HS022651.
Citation: Cottrell EK, Hall JD, Kautz G .
Reporting from the front lines: implementing Oregon's alternative payment methodology in federally qualified health centers.
J Ambul Care Manage 2017 Oct/Dec;40(4):339-46. doi: 10.1097/jac.0000000000000198..
Keywords: Healthcare Delivery, Payment, Patient-Centered Healthcare, Policy, Primary Care
Clark KD, Miller BF, Green LA
Implementation of behavioral health interventions in real world scenarios: managing complex change.
This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. It offers an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care.
AHRQ-funded; HS022981.
Citation: Clark KD, Miller BF, Green LA .
Implementation of behavioral health interventions in real world scenarios: managing complex change.
Fam Syst Health 2017 Mar;35(1):36-45. doi: 10.1037/fsh0000239.
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Keywords: Behavioral Health, Patient-Centered Healthcare, Primary Care, Implementation, Organizational Change, Healthcare Delivery
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams