Assessing Disruption Impact on Quality Improvement Activities Designed to Improve HPV Vaccination in Rural Primary...

Area of Science:

• Health Services Research
• Quality Improvement Science
• Rural Health

Background:

• Primary care clinics implement quality improvement (QI) projects to enhance patient care.
• Disruptions, such as staffing changes, can impede QI initiatives.
• Research on how primary care clinics manage disruptions during QI is limited.

Purpose of the Study:

• To explore the types and impacts of disruptions in rural primary care clinics.
• To identify factors contributing to clinic resilience during a Human Papillomavirus (HPV) vaccination QI study.

Main Methods:

• A mixed-methods, longitudinal design was employed.
• Clinic-level vaccination outcomes and disruption frequency/type were assessed.
• Qualitative case studies examined resilience factors.

Main Results:

• All 41 rural clinics experienced disruptions, most commonly staffing loss (90%).
• Disruption frequency or type did not correlate with HPV vaccination improvement.
• Resilience was shaped by clinic characteristics, practice facilitator support, and disruption characteristics.

Conclusions:

• Disruptions did not predict vaccination improvement outcomes.
• Multiple factors influence clinic resilience and sustained QI efforts.
• Enhancing facilitators is crucial for supporting primary care clinics facing challenges.