"Improvement guidance derived largely from hospital-based studies is, for the most part, applicable to improvement efforts in primary care settings, although large-scale change in general practice presents some particular challenges. These need to be better understood and addressed if improvement initiatives are to be effective."
Understanding quality improvement at scale in general practice: a qualitative evaluation of a COPD improvement programme
M Marshall et al.
British Journal of General Practice, 2014; 64(629): e745–e751. doi: 10.3399/bjgp14X682801
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