A practice change model for quality improvement in primary care practice.

(PMID:15190858) Abstract Citations BioEntities Related Articles Cohen D, McDaniel RR Jr, Crabtree BF, Ruhe MC, Weyer SM, Tallia A, Miller WL, Go odwin MA, Nutting P, Solberg LI, Zyzanski SJ, Jan CR, Gilchrist V, Stange KC Department of Family Medicine, University of Medicine and Dentistry of New Jerse y, Robert Wood Johnson Medical School, USA. debbiec@nac.net Journal of Healthcare Management / American College of Healthcare Executives [20 04, 49(3):155-68; discussion 169-70] Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Su pport, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S. Abstract Highlight Terms No biological terms identified Faced with a rapidly changing healthcare environment, primary care practices oft en have to change how they practice medicine. Yet change is difficult, and the p rocess by which practice improvement can be understood and facilitated has not b een well elucidated. Therefore, we developed a model of practice change using da ta from a quality improvement intervention that was successful in creating a sus tainable practice improvement. A multidisciplinary team evaluated data from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized cl inical trial conducted to improve the delivery of evidence-based preventive serv ices in 79 northeastern Ohio practices. The team conducted comparative case-stud y 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 interrelationsh ips. 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 u nderstand the change options. Change is influenced by the complex interaction of factors inside and outside the practice. Interventions that are based on unders tanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice. http://ukpmc.ac.uk/abstract/MED/15190858/reload=0;jsessionid=tuZiLtv7yZOvtAs4HFJ w.22