A Practice Change Model for Quality Improvement in Primary Care Practice

Cohen, Deborah; McDaniel, Reuben R.; Crabtree, Benjamin F.; Ruhe, Mary C.; Weyer, Sharon M.; Tallia, Alfred F.; Miller, William L.; Goodwin, Meredith A.; Nutting, Paul A.; Solberg, Leif I.; Zyzanski, Stephen J.; Jaén, Carlos Roberto; Gilchrist, Valerie; Stange, Kurt C.

doi:10.1097/00115514-200405000-00005

Cited by 184 publications

(216 citation statements)

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“…13,18,24,31,[49][50][51][52] Practice facilitation recognizes that imposed mandates for change are not likely to be sustained, and that incorporation of evidence-based practice requires tailoring an intervention based on individual practice needs. 21,24,26 Facilitators develop ongoing relationships with practices to perform audits, feedback, training, and system redesign.…”

Section: Interventionmentioning

confidence: 99%

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Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children receive only half of recommended health care; disadvantaged children have higher risk of unmet needs. Practice coaching combined with quality improvement using rapid-cycle feedback has potential to help practices meet quality standards and improve pediatric health care delivery. WHAT THIS STUDY ADDS:The Practice-tailored Facilitation Intervention led to large and sustained improvements in preventive service delivery, including substantial numbers of disadvantaged children, and in multiple simultaneous health care domains. Practice-tailored facilitation holds promise as a method to advance pediatric preventive care delivery. abstract OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS:In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS:Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: ,0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P , .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P , .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.

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Section: Interventionmentioning

confidence: 99%

“…52 Emergent themes were discussed, challenged, and refined during multiple meetings, and cross-cutting themes were identified.…”

Section: Comparative Case Study Analysesmentioning

confidence: 99%

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

et al. 2014

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“…This analysis is part of a multi-method study, conceptually informed by The Primary Care Change Model 27 and the Technology Acceptance Model, [28][29][30][31][32][33][34] to understand how EHRs are used in small, independent primary care practices.…”

Section: Methodsmentioning

confidence: 99%

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Howard¹,

Clark²,

Friedman³

et al. 2012

J GEN INTERN MED

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BACKGROUND:The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices. OBJECTIVE: To study the impact of EHR use on clinician and staff work burden in small, communitybased primary care practices. DESIGN: We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach. PARTICIPANTS: All practice members and selected patients in seven community-based primary care practices in the Northeastern US. KEY RESULTS: The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHRrelated work burden for clinicians, as well as facilitate population-based care. CONCLUSIONS: The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.KEY WORDS: electronic health records; primary care; work burden; qualitative research.

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“…Several frameworks for implementing and assessing organizational changes have been constructed (Glasgow et al, 1999;Cohen et al, 2004;Damschroder et al, 2009;Weiner, 2009;Holt et al, 2010). Cohen et al (2004) identified attributes of practices that achieved high rates of intervention adoption and described four major domains (i.e., resources, stakeholder motivation, outside motivators, and opportunities for change) in the Practice Change and Development Model (Cohen et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…Cohen et al (2004) identified attributes of practices that achieved high rates of intervention adoption and described four major domains (i.e., resources, stakeholder motivation, outside motivators, and opportunities for change) in the Practice Change and Development Model (Cohen et al, 2004). While each individual domain is important, the interdependencies among the domains is critical to understanding and executing change.…”

Section: Introductionmentioning

confidence: 99%

Capability for Change at Community Health Centers Serving Asian Pacific Islanders: An Exploratory Study of a Cancer Screening Evidence-based Intervention

Sohng

Kuniyuki

Edelson

et al. 2013

Asian Pacific Journal of Cancer Prevention

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A Practice Change Model for Quality Improvement in Primary Care Practice

Cited by 184 publications

References 0 publications

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Capability for Change at Community Health Centers Serving Asian Pacific Islanders: An Exploratory Study of a Cancer Screening Evidence-based Intervention

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