Table 2.

Summary of the empirical articles reviewed: N = 57.

STUDYLOCATIONSETTINGSTUDY PURPOSEMETHOD AND SAMPLE
Quality indicator studies
Ballard,13 2003USPCDescribe elements of change involved in implementing QIQualitative case study; 1 health care system
Exworthy et al,14 2003UKPCExamine effect of PI on GPs’ clinical autonomyInterviews; 52 GPs, nurses, and managers
Gorrell et al,15 2004AustraliaMHMeasure change in service after introducing specialized teamsAudit; 47 in control group, 70 in treatment group
McColl et al,6 2000UKPCTest feasibility of deriving QI in all practices in a PCGRetrospective audit; 18 practices in 1 PCG
Wilkinson et al,16 2000UKPCStudy PC clinicians’ reactions to the use of PIsInterviews; 29 GPs, 11 practice managers, 12 nurses
Clinical practice guideline studies
Brown et al,17 2000USPC, MHEvaluate effectiveness of 2 CPG implementation methodsRCT, quasi-experimental; physicians, nurses, assistants
Cabana et al,18 2000USPCDescribe barriers to successful use of asthma CPGsFocus groups; 22 participants
Cabana et al,19 2001USPCIdentify barriers to GP adherence to asthma CPGsCross-sectional survey; 829 random GPs
Cranney et al,20 2001UKPCIdentify what impedes use of hypertension CPGsInterviews; 34 random GPs
Eccles et al,21 2002UKPCEvaluate computerized support system for implementing CPGsRCT; 60 GPs
Goldberg et al,22 1998USPCDetermine effectiveness of interventions on compliance with CPGsRCT; 15 small group practices in 4 PC clinics
Gupta et al,23 1997AustraliaPCDetermine GPs’ views on and recall of CPGsQuestionnaire; 286 random GPs
Gupta et al,24 1997AustraliaPCExamine GPs’ views on CPGsSurvey; 286 GPs
Hermens et al,25 2001NetherlandsPCAssess the key elements of a successful implementationProspective cohort study; 1586 random GPs
Kaner et al,26 1999UKPCEvaluate training and support in implementation of interventionRCT; 128 GPs
Karuza et al,27 1995USPCDevelop and evaluate dissemination interventionRCT; 13 group practices and 5 PC GPs
Lin et al,28 1997USPC, MHExamine whether education has an effect on treatmentQuantitative, quasi-experimental
Nutting et al,29 2002USPC, MHExamine why GPs and nurses were not using depression CPGsCluster analysis, interviews; 6 nurses, 12 GPs
Picken et al,30 1998USPCAssess level of modification of CPGs by PC physiciansQuantitative modified Delphi approach; 68 random GPs
Puech et al,31 1998AustraliaPCExamine care patterns and strategies for local implementation of CPGsQuestionnaire; 83 random GPs
Rashidian and Russell,32 2003UKPCDevelop model for implementing CPGsInterviews; 25 GPs and PC academics
Rollman et al,33 1999USPC, MHDescribe steps of disseminating CPGs by EMRsQualitative, descriptive; PC physicians
Silagy et al,34 2002AustraliaPCDetermine effects of local adaptation of CPGsSurvey; 400 random GPs from 2 practice divisions
Smith et al,35 2004UKPC, MHExamine GPs’ views on using CPGsInterviews; 11 GPs
Thompson et al,36 2000UKPC, MHAssess effectiveness of educational programRCT; 60 PC physicians
Health care innovation studies
Aupont,37 2001USPC, MHAnalyze how quality improvement affects provider behaviourQuantitative, qualitative survey; 26 providers, 30 000 patients
Benjamin and Seaman,38 1998BahrainPCDiscuss lessons learned from implementing an innovationQualitative case study; 1 health centre
Bentz et al,39 2002USPCPilot-test 2 tobacco tracking systemsQualitative case study; 2 PC offices
Brown et al,40 2003USPCDescribe the redesign process using a quality modelQualitative case study; 1 service area
Byrne et al,41 2004USPC, MHDetermine effects of clinical service lines on inpatient and urgent care useSurvey; 140 directors of health facilities
Campbell et al,42 2002UKPCInvestigate the concept of clinical governanceQualitative case study; 12 PC groups or trusts
Cohen et al,43 2004USPCDevelop a model of practice changeQualitative comparative case study; 15 practices
Cox et al,44 1999UKPCImprove the repeat-prescribing processQualitative case study; 1 practice of 7 GPs
Earnest et al,45 1998USPCDescribe various strategies of quality and performance improvementQualitative case study; 1 urban health care system
Feifer et al,46 2003USPCDiscuss the self-managing team concept and illustrate its applicationQualitative case study; 1 practice centre
Fischer et al,47 1998USPCAnalyze case studies from a quality improvement projectQualitative case study; 6 random clinics
Frijling et al,48 2003NetherlandsPCTest transferability of observations from research to real-life situationsControlled before-and-after trial; 617 general practices
Gillespie et al,49 2004UKPCExplore how the term patient-centred care is understoodInterviews; 47 individuals
Hermann et al,50 2001USPC, MHDescribe an implementation process and its outcomesQualitative descriptive study; 11 health centres, 1599 patients
Hogg et al,51 2002CanadaPCUnderstand the role of a facilitator in preventive performanceQualitative case study; 7 practices
Holden,52 2002UKPCEvaluate a PC audit groupQualitative case study; 1 audit group
Jackson and Bircher,53 2002UKPCExamine how a new model transformed a general practiceQualitative case study; 1 medical centre
John et al,54 2001UKPCDescribe a benchmarking projectQualitative prospective longitudinal cohort study; 8 service trust sites
Knox et al,55 2001USPCIdentify strategies for improving staff performanceQualitative, quantitative in-depth cross-case analysis; 8 practices
Korsen et al,56 2003USPC, MHImplement a multifaceted interventionQualitative case study; 2 practices
Ledlow and Bradshaw,57 1999USPCImprove practice using an animated simulation toolQualitative case study; 1 family practice
Lövgren et al,58 2001SwedenPCExplore physicians’ and nurses’ views on adopting a new care policyQualitative interview; 50 physicians and nurses
Magnan et al,59 1997USPCExamine turmoil during a quality improvement projectSurvey; 44 clinics
Marshall et al,60 2002UKPCInvestigate importance of culture in implementing clinical governanceQualitative case study; 12 PC groups or trusts, 50 senior PC managers
Nemeth,61 2003USPCAnalyze a quality improvement interventionQualitative fieldwork; 6 cases
Rubenstein et al,62 2002USPCAssess how quality improvement teams affect a programInterviews, observation; 2 large PC practices, 5 QI teams
Solberg et al,63 1999USPC, MHAssess need for and acceptability of depression care systemFocus groups and survey
Tobin and Norris,64 1998AustraliaPC, MHReport on a project to implement total quality management strategiesInterviews; 100 MH staff and GPs
Townes et al,65 2000USPCDevelop and implement a changeQualitative case study; 1 health centre
Willcocks,66 2003UKPCExplore early experiences of a new PC organizationQualitative longitudinal case study; 1 PC group
Zapka et al,67 2004USPCPresent a process evaluationQualitative case study, randomized trial; 6 community health centres
Zomalt,68 1997USPC, MHStudy staff perspective of doing continuous quality improvementQualitative case study; day rehabilitation program staff

  • CPG—clinical practice guideline, EMR—electronic medical record, GP—general practitioner, MH—mental health, PC—primary care, PCG—primary care group, PI—performance indicator, QI—quality indicator, RCT—randomized controlled trial.