{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:52Z","timestamp":1777859032922,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["RSG-18-022-010"],"award-info":[{"award-number":["RSG-18-022-010"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319261421183","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T09:22:15Z","timestamp":1772529735000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing Disruption Impact on Quality Improvement Activities Designed to Improve HPV Vaccination in Rural Primary Care"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6959-3254","authenticated-orcid":false,"given":"Chrystal","family":"Barnes","sequence":"first","affiliation":[{"name":"Oregon Rural Practice-based Research Network, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9418-2495","authenticated-orcid":false,"given":"NithyaPriya","family":"Ramalingam","sequence":"additional","affiliation":[{"name":"Oregon Rural Practice-based Research Network, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steele","family":"Valenzuela","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5956-5936","authenticated-orcid":false,"given":"Caitlin","family":"Dickinson","sequence":"additional","affiliation":[{"name":"Oregon Rural Practice-based Research Network, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9951-4643","authenticated-orcid":false,"given":"Kylie","family":"Lanman","sequence":"additional","affiliation":[{"name":"Oregon Rural Practice-based Research Network, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2937-655X","authenticated-orcid":false,"given":"Patricia A.","family":"Carney","sequence":"additional","affiliation":[{"name":"Oregon Rural Practice-based Research Network, Oregon Health &amp; Science University, Portland, OR, USA"},{"name":"Department of Family Medicine, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1828-7279","authenticated-orcid":false,"given":"Brigit A.","family":"Hatch","sequence":"additional","affiliation":[{"name":"Oregon Rural Practice-based Research Network, Oregon Health &amp; Science University, Portland, OR, USA"},{"name":"Department of Family Medicine, Oregon Health &amp; Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1713"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2172"},{"issue":"3","key":"e_1_3_3_4_2","article-title":"A practice change model for quality improvement in primary care practice","volume":"49","author":"Cohen D","year":"2004","unstructured":"Cohen D, McDaniel RRJr, Crabtree BF, et al. A practice change model for quality improvement in primary care practice. J Healthc Manag. 2004;49(3):155-168; discussion 169-170.","journal-title":"J Healthc Manag"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181cad65c"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0555-2"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2021.04.210011"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2019.71"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2201"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2022.01.210205"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2020.05.200058"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004479-200407000-00008"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2015.49"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-11-100"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2007.02.060140"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-019-0871-9"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/003335491513000209"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12724"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.5688\/ajpe7113"},{"issue":"2","key":"e_1_3_3_22_2","article-title":"EHRs in primary care practices: benefits, challenges, and successful strategies","volume":"18","author":"Goetz Goldberg D","year":"2012","unstructured":"Goetz Goldberg D, Kuzel AJ, Feng LB, DeShazo JP, Love LE. EHRs in primary care practices: benefits, challenges, and successful strategies. Am J Manag Care. 2012;18(2):e48-e54.","journal-title":"Am J Manag Care"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2891-0"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1256"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.0130"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-015-0028-0"},{"key":"e_1_3_3_27_2","author":"Thomas S","year":"2020","unstructured":"Thomas S, Sagan A, Larkin J, Cylus J, Figueras J, Karanikolos M. Strengthening health systems resilience: Key concepts and strategies. European Observatory Policy Briefs; 2020.","journal-title":"Strengthening health systems resilience: Key concepts and strategies"}],"container-title":["Journal of Primary Care &amp; Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319261421183","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501319261421183","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319261421183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:23:52Z","timestamp":1777508632000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501319261421183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":26,"alternative-id":["10.1177\/21501319261421183"],"URL":"https:\/\/doi.org\/10.1177\/21501319261421183","relation":{},"ISSN":["2150-1319","2150-1327"],"issn-type":[{"value":"2150-1319","type":"print"},{"value":"2150-1327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"21501319261421183"}}