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Increasing Capacity for Quality Improvement in Underresourced Primary Care Settings

Hudson, Shannon M. PhD, RN; Hiott, Deanna B. MSN, RN; Cole, Jeff MBA; Davis, Robert MS; Egan, Brent M. MD; Laken, Marilyn A. PhD, RN, FAAN

doi: 10.1097/QMH.0000000000000031
Original Articles

While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed.

College of Nursing, Medical University of South Carolina, Charleston (Drs Hudson and Laken); Mary Black School of Nursing, University of South Carolina Upstate, Spartanburg (Ms Hiott); JCG Management Consulting, Centerville, Ohio (Mr Cole); Care Coordination Institute, Greenville, South Carolina (Mr Davis); and Department of Medicine, University of South Carolina at Greenville (Dr Egan).

Correspondence: Shannon M. Hudson, PhD, RN, College of Nursing, Medical University of South Carolina, 19 Hagood Ave, Harborview Office Tower, Ste 304H2, Charleston, SC 29425 (

This project was funded in part by Centers for Disease Control and Prevention grant 16000-14-35228 to the University of South Carolina.

Dr Brent Egan reports ongoing relationships as a paid board member for Power Over Pressure, a consultant on treatment resistant hypertension for Medtronic, and past relationships with Medtronic, Novartis, and Takeda. Mr Robert Davis reports consultancy to Blue Cross Blue Shield of South Carolina and ongoing relationships with Medtronic and Quintiles. The other authors report no real or potential conflicts of interest.

© 2014Wolters Kluwer Health | Lippincott Williams & Wilkins