Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study

Area of Science:

• Health Services Research
• Primary Care Medicine
• Quality Improvement Science

Background:

• Implementing evidence-based practices in primary care relies on quality improvement (QI) projects.
• Recruiting physician practices for QI initiatives is often challenging, resource-intensive, and time-consuming.

Purpose of the Study:

• To identify reasons why primary care practices decline participation in QI projects.
• To explore strategies for enhancing the feasibility and attractiveness of future QI projects.

Main Methods:

• A qualitative study involving interviews and questionnaires with representatives from practices that declined participation.
• Thematic analysis was employed to analyze qualitative data from 31 practice representatives.

Main Results:

• Staff turnover, shortages, and time constraints (exacerbated by the pandemic) were primary reasons for non-participation.
• Secondary reasons included electronic health record challenges, desire for greater financial compensation, and confidence in current practices.
• Respondents suggested linking participation to value-based programs and increasing compensation, but these did not address core staffing/time issues.

Conclusions:

• Pandemic-related staffing challenges and time constraints significantly hinder primary care practices' engagement in QI research.
• Policy interventions should focus on direct support for primary care to alleviate burnout and improve capacity for QI participation.