A Nurse Coach Quality Improvement Intervention

Abstract

As the U.S. population ages and chronic illness prevalence increases, new approaches to care are needed. Although large health systems have begun to respond to this challenge, most Americans seek care from practitioners functioning in small office settings. Implementing systematic sustainable changes for quality improvement in this setting remains an unresolved challenge. In this study, trained Nurse Coaches (NCs) were employed to assist practices in adopting a new model of patient care called Virtual Integrated Practice (VIP). The feasibility and treatment fidelity of this approach were assessed through process measures and interviews in three practices. Findings document high acceptance of the NC approach and consistent delivery of the intervention. Enactment of the VIP model took place across practices, although to a variable degree. The study suggests that NCs may be an effective delivery method for quality and organizational improvements in small primary care practices.

Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review

“…It was unclear who intervention deliverers were in 12 studies (21.8%) [26, 39, 46, 50, 51, 55, 59–64], but in studies where this information was identifiable, deliverers were most frequently nurses (10 studies, 18.2%) [33, 35–37, 40, 47, 52, 65–67]. With regards to level and mode of delivery, interventions were most frequently delivered at the individual (25 studies, 45.5%) [27–29, 33, 34, 40, 41, 45, 46, 48, 50–52, 54, 56, 60, 63, 65, 66, 68–73] and group level (19 studies, 35.1%) [26, 31, 32, 38, 39, 42, 43, 49, 53, 55, 58, 61, 62, 64, 67, 74–77]. Face to face was the most common (28 studies, 50.9%) mode of delivery [27, 29, 31, 32, 35–38, 41–45, 49, 50, 56, 58, 60–62, 66–68, 74–78].…”

“…1 to locate these in the PRISMA diagram), 33 (19.6%) of which addressed receipt (studies 1–33 in Table 5). Although all 33 papers cited the BCC framework, 5 (15.2%) papers were not worded in a way to suggest that this framework had informed the fidelity or process evaluation reported [28, 39, 66, 67, 77]. …”

“…An assessment of participants’ understanding was included in 20 (60.6%) studies [25, 29, 31, 33–37, 39, 45, 47, 48, 50, 57, 61, 65, 67, 73, 75, 78] and an assessment of participants’ performance of intervention-related skills in 14 (42.4%) studies [33–36, 45, 47, 48, 51, 54, 56, 57, 65, 75, 78]. With regards to strategies to enhance receipt, 4 (12.1%) studies reported using a strategy to enhance participants’ understanding [41, 48, 56, 57], 7 (21.1%) to enhance performance of intervention-related skills [39, 41, 44, 47, 48, 56, 57].…”

“…none of the studies included from the electronic database search reported using the BCC framework). Other frameworks that informed the studies reviewed included the process evaluation framework by Linnan and Steckler (2002) [22] in 11 (20.0%) [27, 46, 52, 53, 55, 60, 66, 68, 69, 71, 74], Lichstein et al’s Treatment Implementation Model (TIM) [21] in 4 (7.3%) studies [28, 39, 40, 67], Saunders et al’s framework [23] in 5 (9.1%) studies [26, 30, 46, 49, 59], the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework [79] in 2 (3.6%) studies [46, 70], Dane & Schneider’s framework [80] in 2 (3.6%) studies [38, 76], Dusenbury et al’s framework [81, 82] in 2 (3.6%) studies [38, 62], Baranowski et al’s framework [83] in 1 (1.8%) study [52]. A brief definition of how receipt is defined in these frameworks is available in notes below the Table in Additional file 2.…”

“…Given the focus of the forward citation search on the BCC framework, the two most common ways of assessing receipt in the 55 studies reviewed were measurements of understanding, included in 26 (47.3%) studies [25, 29–31, 33–37, 39, 40, 45, 47–50, 57, 60–62, 65, 67, 70, 73, 75, 78], and of performance of skills, included in 16 (29.1%) studies [33–36, 45, 47, 48, 51, 54, 56, 57, 65, 70, 71, 75, 78]. …”