Assessing Quality Improvement Capacity in Primary Care Practices

Parchman, Michael L.; Anderson, Melissa L.; Coleman, Katie; Michaels, LeAnn; Schuttner, Linnaea; Conway, Cullen; Hsu, Clarissa; Fagnan, Lyle J.

doi:10.21203/rs.2.10354/v1

Cited by 6 publications

(8 citation statements)

References 25 publications

(28 reference statements)

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“…Our success with these state contracts came, in part, from our reputation with previous implementation research. 22,26,33 These technical assistance contracts then furthered relationships that allowed ORPRN to competitively propose an ECHO network within our PBRN. Our strong connections with state agencies, state and federal lawmakers, and health care systems have aligned ORPRN with new partners who focus not only on clinical expertise but also on health systems, policy, and funding, which is a key strength for the future of our PBRN.…”

Section: Discussionmentioning

confidence: 99%

Project ECHO Integrated Within the Oregon Rural Practice-based Research Network (ORPRN)

et al. 2020

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Two key advancements in improving the quality of primary care have been practice-based research networks (PBRNs) and Project Extension for Community Health care Outcomes (ECHO). PBRNs advance quality through research and transformation projects, often using practice facilitation. Project ECHO uses case-based telementoring to support community clinicians to deliver best-practice care. Although some PBRNs sponsor ECHO programs, the Oregon Rural Practice-based Research Network (ORPRN) has created a statewide network for ECHO programs (Oregon ECHO Network [OEN]). We facilitated a unique funding stream for the OEN by partnering with payers and health systems. The purpose of this article is to share our experience of how OEN programs and ORPRN research and transformation projects enhance practice recruitment and retention and improve financial stability. We describe the synergy between ORPRN projects and ECHO programs using 3 examples: tobacco cessation, chronic pain and opioid prescribing, and diabetes management. We highlight challenges and opportunities in these examples, beginning with their development, their implementation, and their ultimate alignment, despite varied funding streams and timelines. We believe that incorporating the OEN within ORPRN has been a success for both PBRN research and Project ECHO programs, allowing us to better support primary care practices across the state.

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Section: Discussionmentioning

confidence: 99%

Project ECHO Integrated Within the Oregon Rural Practice-based Research Network (ORPRN)

et al. 2020

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“…A wide range of other readiness assessment tools exist and could be adapted, including the Practice Transformation Readiness Assessment and Quality Improvement Capacity Assessment. (35,36) Others have used CFIR to assess readiness for implementation, suggesting that readiness is often captured by two CFIR domains: inner setting (e.g., readiness for implementation, implementation climate, networks and communication) and characteristics of individuals. (37) Speci cally, for LDCT, an assessment could include identifying competing priorities, concurrent activities, ongoing or upcoming systems challenges, and system readiness.…”

Section: Discussionmentioning

confidence: 99%

Successes and Challenges of Implementing a Lung Cancer Screening Program in Federally Qualified Health Centers: A Qualitative Analysis Using the Consolidated Framework for Implementation Research

Allen

Cotter

Smith

et al. 2020

Preprint

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Background: The American Cancer Society (ACS) partnered with two federally qualified health centers (FQHCs) and American College of Radiology designated lung cancer screening facilities on a two-year pilot project to implement lung cancer screening. The project aimed to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Methods: Evaluators conducted key informant interviews (N=46) with navigators, clinical staff, administrators from both sites, and ACS staff during annual site visits in 2017 and 2018 to capture data on implementation barriers and facilitators. Three evaluators conducted a thematic analysis using the Consolidated Framework for Implementation Research (CFIR) and assessed factors associated with effective implementation and improved screening outcomes.Results: One study site established a sustainable lung screening program, while the other encountered numerous implementation barriers which they failed to overcome. CFIR constructs highlighted critical barriers and factors associated with success and improved outcomes. Intervention Characteristics: Time spent with patients and disruption to normal workflows were challenges to implementation at both sites. Outer Setting: Both sites struggled with building patient trust and worked to gain trust by providing clear, consistent information about the screening process. One site was located in a state with Medicaid expansion that reimbursed screening but the other was not. Inner Setting: Engaged, supportive leaders who provided clear, consistent communication about implementation helped improve staff capacity, which was critical to building a successful program. Individual Characteristics: Knowledgeable, confident champions and intervention leaders were able to train, guide, and motivate staff throughout the intervention, whereas the absence of supportive leadership failed to produce staff champions and intervention leaders. Process: A slow, stepwise approach to implementation at one site allowed project champions to pilot-test the referral and reimbursement processes and resolve issues before scaling-up.Discussion: This pilot project provides insight into critical resources and steps for successful program implementation in underserved FQHC settings. Future efforts could build upon these findings by considering self-assessment and monitoring tools that incorporate CFIR constructs to help identify and address possible facilitators and barriers to implementation of LDCT.

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“…opportunity to develop an organizational readiness tool specifically for small practices that could draw upon the findings of our study. Two existing tools serve as strong starting points: (1) the Quality Improvement Capacity Assessment (QICA), which is based on medical home principles and assesses capacity for QI in small practices, a component of readiness for change 33 and (2) the Organizational Readiness to Change Assessment instrument (ORCA), which has been widely used to assess implementation of evidence-based practices in large health organizations. 34 Neither assess EHR skills and competencies, however, which our study suggests is important to the success of QI projects.…”

Section: Discussionmentioning

confidence: 99%

Attributes of High-Performing Small Practices in a Guideline Implementation: A Multiple-Case Study

Nguyen

Cuthel

Rogers

et al. 2020

J Prim Care Community Health

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Objective HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation on the adoption of cardiovascular disease guidelines in small primary care practices. The objective of this study was to identify was to identify attributes of small practices that signaled they would perform well in a practice facilitation intervention implementation. Methods A mixed methods multiple-case study design was used. Six small practices were selected representing 3 variations in meeting the practice-level benchmark of >70% of hypertensive patients having controlled blood pressure. Inductive and deductive approaches were used to identify themes and assign case ratings. Cross-case rating comparison was used to identify attributes of high performing practices. Results Our first key finding is that the high-performing and improved practices in our study looked and acted similarly during the intervention implementation. The second key finding is that 3 attributes emerged in our analysis of determinants of high performance in small practices: (1) advanced use of the EHR; (2) dedicated resources and commitment to quality improvement; and (3) actively engaged lead clinician and office manager. Conclusions These attributes may be important determinants of high performance, indicating not only a small practice’s capability to engage in an intervention but possibly also its readiness to change. We recommend developing tools to assess readiness to change, specifically for small primary care practices, which may help external agents, like practice facilitators, better translate intervention implementations to context.

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Assessing Quality Improvement Capacity in Primary Care Practices

Cited by 6 publications

References 25 publications

Project ECHO Integrated Within the Oregon Rural Practice-based Research Network (ORPRN)

Project ECHO Integrated Within the Oregon Rural Practice-based Research Network (ORPRN)

Successes and Challenges of Implementing a Lung Cancer Screening Program in Federally Qualified Health Centers: A Qualitative Analysis Using the Consolidated Framework for Implementation Research

Attributes of High-Performing Small Practices in a Guideline Implementation: A Multiple-Case Study

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