Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study

Milton Eder, Rachel Jacobsen, Kevin A Peterson, Leif I Solberg

Research output: Contribution to journalArticlepeer-review


Objective To learn how high performing primary care practices organized care for patients with diabetes during the initial months of the COVID-19 pandemic. Participants and methods Semi-structured interviews were conducted between August 10 and December 10, 2020 with 16 leaders from 11 practices that had top quartile performance measures for diabetes outcomes pre-COVID. Each clinic had completed a similar interview and a survey about the existence of care management systems associated with quality outcomes before the pandemic. Transcript analysis utilized a theoretical thematic analysis at the semantic level. Results The pandemic disrupted the primary care practices' operations and processes considered important for quality prior to the pandemic, particularly clinic reliance on proactive patient care. Safety concerns resulted from the shift to virtual visits, which produced documentation gaps and led practices to reorder their use of proactive patient care processes. Informal interactions with patients also declined. These practices' challenges were mitigated by technical, informational and operational help from the larger organizations of which they were a part. Care management processes had to accommodate both in-person and virtual visits. Conclusion These high performing practices demonstrated an ability to adapt their use of proactive patient care processes in pursuing quality outcomes for patients with diabetes during the pandemic. Continued clinic transformation and improvements in quality within primary care depend on the ability to restructure the responsibilities of care team members and their interactions with patients.

Original languageEnglish (US)
Article numbere0278410
JournalPloS one
Issue number12 December
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health under Award Number R18DK110732 (KP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No author reports any conflict of interest.

Publisher Copyright:
Copyright: © 2022 Eder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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