Table 3.
An Ongoing Federally Funded Research Program to Understand Primary Care Practice Change and Improvement*
| Project Name (Acronym) | Funding Source and Dates | Aim | Design and Sample | Findings |
|---|---|---|---|---|
| Direct Observation of Primary Care (DOPC) | NCI R01 CA60862 (PI, Stange) 1994–1997 | Understand the content and context of primary care practice with a particular focus on preventive service delivery | Multimethod study of 4,454 patient visits to 138 physicians from 84 practices in Ohio | The value of the complexly related processes of primary care is from integration of breadth, depth, bridging boundaries, and guiding access. |
| Prevention and Competing Demands in Primary Care (P&CD) | AHRQ R01 HS08776 (PI, Crabtree) 1996–1999 | Understand preventive service delivery within the context of the competing demands of primary care practice | Ethnographic comparative case studies of 18 practices in Nebraska | Each practice is unique because of history and initial conditions, particular agents, patterns of nonlinear interactions among agents, the local fitness landscape, and evolving regional and global influences. |
| Study to Enhance Prevention by Understanding Practice (STEP-UP) | NCI 2R01 CA60862 (PI, Stange) 1997–2001 | Improve preventive service delivery through practice-individualized interventions | Group randomized trial of 80 Ohio practices | Practice-individualized, facilitated intervention can result in sustained improvement in preventive service delivery. |
| Using Learning Teams for Reflective Adaptation (ULTRA) | NHLBI R01 HL70800 (PI, Crabtree) 2002–2008 | Improve to enhance relationships and cardiovascular disease care through Reflective Adaptive Processes | Group randomized trial of 60 New Jersey and Pennsylvania practices | A Reflective Adaptive Process can improve practice communication and processes, but these changes may not be reflected in narrowly construed process measures of quality of care. |
*
NCI, National Cancer Institute; PI, Principal Investigator; AHRQ, Agency for Healthcare Research and Quality; NHLBI, National Heart Lung and Blood Institute.