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

Abstract

Primary care clinics often undertake quality improvement (QI) projects to enhance care delivery. Disruptions to clinical practice, such as staffing changes, can hinder QI efforts. Limited research examines how primary care clinics experience and respond to disruptions. This study explores the types and impacts of disruptions and factors linked to resilience for rural clinics during a Human Papillomavirus (HPV) vaccination QI study. We used a mixed-methods, longitudinal design to assess disruption frequency and type alongside clinic-level vaccination outcomes. Qualitative case studies explored how disruptions influenced QI participation and resilience factors. Among 41 rural clinics studied, all reported at least 1 disruption during QI implementation, including staffing loss (37 clinics, 90%), EHR implementation (10 clinics, 24%), and organizational changes (4 clinics, 9%). Disruption frequency and type did not differ across quartiles of HPV vaccination improvement. Eight clinics were selected for in-depth case study analysis, which revealed factors shaping resilience: (1) clinic characteristics, (2) practice facilitator support, and (3) disruption characteristics. Disruption type or number did not explain differences in vaccination improvement. Multiple factors were found to influence resilience and continued QI. Identifying and enhancing these facilitators is critical to supporting primary care clinics through inevitable challenges.