National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Cancer (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Evidence-Based Practice (1)
- Healthcare Delivery (6)
- Implementation (2)
- (-) Organizational Change (12)
- Patient-Centered Healthcare (6)
- Patient Experience (1)
- Policy (1)
- Practice Improvement (5)
- (-) Primary Care (12)
- Primary Care: Models of Care (4)
- Provider (2)
- Provider Performance (1)
- Quality Improvement (9)
- (-) Quality of Care (12)
- Substance Abuse (1)
- Teams (2)
- Urban Health (1)
- Vulnerable Populations (1)
- Workflow (3)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 12 of 12 Research Studies DisplayedMcHugh M, Heinrich J, Philbin S
Declining participation in primary care quality improvement research: a qualitative study.
This qualitative study’s aim was to identify factors leading primary care practices to decline participation in quality initiative (QI) projects, and strategies to improve the feasibility and attractiveness of QI projects in the future. The authors contacted 109 representatives of practices that had declined participation in 1 of 4 AHRQ-funded EvidenceNOW projects. The representatives were invited to either participate in a 15-minute interview or complete a 5-question questionnaire. Representatives from 31 practices responded. Reasons for declining included staff turnover, staffing shortages, and general time constraints, exacerbated by the pandemic, preventing participation in the QI projects. Secondary reasons included challenges with electronic health records, an expectation of greater financial compensation for participation, and confidence in the practices' current care practices. Tying participation to value-based programs and offering greater compensation were identified as strategies to facilitate recruitment. However, none of the respondents’ recommendations addressed the primary issues of staffing challenges and time constraints.
AHRQ-funded; HS027954.
Citation: McHugh M, Heinrich J, Philbin S .
Declining participation in primary care quality improvement research: a qualitative study.
Ann Fam Med 2023 Sep-Oct; 21(5):388-94. doi: 10.1370/afm.3007..
Keywords: Quality Improvement, Primary Care, Quality of Care, Practice Improvement, Organizational Change, Evidence-Based Practice
Hung DY, Harrison MI, Liang SY
AHRQ Author: Harrison MI
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY .
Contextual conditions and performance improvement in primary care.
Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organizational Change, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
Hung DY, Gray CP, Truong QA
AHRQ Author: Harrison MI
Sustainment of lean redesigns for primary care teams.
This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. Results showed that staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Gray CP, Truong QA .
Sustainment of lean redesigns for primary care teams.
Qual Manag Health Care 2019 Jan/Mar;28(1):15-24. doi: 10.1097/qmh.0000000000000200..
Keywords: Primary Care, Workflow, Teams, Organizational Change, Quality Improvement, Quality of 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
Kerrissey M, Satterstrom P, Leydon N
Integrating: a managerial practice that enables implementation in fragmented health care environments.
This inductive qualitative study examines primary care clinics implementing improvement efforts in order to identify mechanisms that enable implementation despite common barriers, such as lack of time and fragmentation across stakeholder groups. It found that successfully implementing clinics exhibited the managerial practice of integrating, which was defined as achieving unity of effort among stakeholder groups in the pursuit of a shared and mutually developed goal.
AHRQ-funded; HS019508.
Citation: Kerrissey M, Satterstrom P, Leydon N .
Integrating: a managerial practice that enables implementation in fragmented health care environments.
Health Care Manage Rev 2017 Jul/Sep;42(3):213-25. doi: 10.1097/hmr.0000000000000114.
.
.
Keywords: Primary Care, Quality Improvement, Organizational Change, Implementation, Quality of Care
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.
.
.
Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Gray CP, Harrison MI, Hung D
AHRQ Author: Harrison MI
Medical assistants as flow managers in primary care: challenges and recommendations.
Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, the authors found that using medical assistants (Mas) as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Gray CP, Harrison MI, Hung D .
Medical assistants as flow managers in primary care: challenges and recommendations.
J Healthc Manag 2016 May-Jun;61(3):181-91.
.
.
Keywords: Primary Care, Organizational Change, Practice Improvement, Quality Improvement, Quality of Care, Workflow, Provider
Solberg LI, Stuck LH, Crain AL
Organizational factors and change strategies associated with medical home transformation.
The researchers surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. The Change Process Capability Questionnaire survey and the Physician Practice Connections survey showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies.
AHRQ-funded; HS019161.
Citation: Solberg LI, Stuck LH, Crain AL .
Organizational factors and change strategies associated with medical home transformation.
Am J Med Qual 2015 Jul-Aug;30(4):337-44. doi: 10.1177/1062860614532307.
.
.
Keywords: Patient-Centered Healthcare, Primary Care, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Healthcare Delivery
Nembhard IM, Yuan CT, Shabanova V
The relationship between voice climate and patients' experience of timely care in primary care clinics.
The aims of this study were to assess the relationship between organizational climate and patients’ reports of timely care in primary care clinics and to broadly examine the link between staff’s work environment and patient care experiences. It found that clinical and administrative staff (e.g., nurses and office assistants) reported clinics’ climates to be significantly less supportive of voice than did clinical leaders (e.g., physicians).
AHRQ-funded; HS018987; HS016978.
Citation: Nembhard IM, Yuan CT, Shabanova V .
The relationship between voice climate and patients' experience of timely care in primary care clinics.
Health Care Manage Rev 2015 Apr-Jun;40(2):104-15. doi: 10.1097/hmr.0000000000000017..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Primary Care, Quality of Care, Organizational Change, Provider
Solberg LI, Crain AL, Tillema JO
Challenges of medical home transformation reported by 118 patient-centered medical home (PCMH) leaders.
The authors surveyed newly-certified medical homes in Minnesota to determine the most important organizational factors and strategies for transforming primary clinics into patient-centered medical homes (PCMHs). They found that many items in the survey about transformation seem to have face validity for leaders of certified PCMHs and to be associated with the extent to which their clinics have made systems changes.
AHRQ-funded; HS019161.
Citation: Solberg LI, Crain AL, Tillema JO .
Challenges of medical home transformation reported by 118 patient-centered medical home (PCMH) leaders.
J Am Board Fam Med 2014 Jul-Aug;27(4):449-57. doi: 10.3122/jabfm.2014.04.130303.
.
.
Keywords: Patient-Centered Healthcare, Practice Improvement, Primary Care: Models of Care, Primary Care, Organizational Change, Quality of Care
McNellis RJ, Genevro JL, Meyers DS
AHRQ Author: McNellis RJ, Genevro JL, Meyers DS
Lessons learned from the study of primary care transformation.
This article discusses the patient-centered medical home (PCMH) model. The authors conclude that the transformation of primary care is essential to achieving the triple aim of better outcomes, better value, and better experience of care, and that the PCMH may be the most viable solution in the current health care environment.
AHRQ-authored.
Citation: McNellis RJ, Genevro JL, Meyers DS .
Lessons learned from the study of primary care transformation.
Ann Fam Med 2013 May-Jun;11 Suppl 1:S1-5. doi: 10.1370/afm.1548.
.
.
Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Organizational Change, Quality Improvement, Quality of Care
Taylor EF, Machta RM, Meyers DS
AHRQ Author: Meyers DS, Genevro J
Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.
This article discusses how practice facilitators and care managers can play important but distinct roles in redesigning and improving care delivery in order to deliver coordinated, accessible, comprehensive, and patient-centered care.
AHRQ-authored.
Citation: Taylor EF, Machta RM, Meyers DS .
Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.
Ann Fam Med 2013 Jan-Feb;11(1):80-3. doi: 10.1370/afm.1462.
.
.
Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Organizational Change, Quality Improvement, Quality of Care