Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

Fagnan, Lyle J.; Walunas, Theresa L.; Parchman, Michael L.; Dickinson, Caitlin; Murphy, Katrina M.; Howell, Ross; Jackson, Kathryn; Madden, Margaret B.; Ciesla, James R.; Mazurek, Kathryn; Kho, Abel N.; Solberg, Leif I.

doi:10.1370/afm.2199

Cited by 18 publications

(23 citation statements)

References 20 publications

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“…Although a cost-effectiveness analysis of the intervention was excluded in this review, Culler et al previously found practice facilitation to be cost-neutral while recent work from EvidenceNOW and the Healthy Hearts in the Heartland (H3), Fagnan et al, reported the total average costs of implementation to be $5529 per practice. 61,62 Overall, practice facilitation may further enhance quality improvement initiatives such as the patient-centered medical home (1.3% increase in preventive services) and care coordination (0.2 to 16.4% increase in cancer screening and 0.1 to 8.7% increase in diabetes screening), with electronic health records providing clinical decision support (42% increase in odds of preventive care processes). [63][64][65] Incorporating quality improvement, practice facilitation has a leading role in the transformation of care quality in primary care.…”

Section: Discussionmentioning

confidence: 99%

Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review

et al. 2018

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Overall, the results suggest that practice facilitation may improve chronic disease care measures. Across all studies, practices were aware of practice facilitation. These findings lend support for the potential expansion of practice facilitation in primary care. Future work will need to investigate potential opportunities for practice facilitation to improve chronic disease outcomes in other health care settings (e.g., specialty and multi-specialty practices) with standardized measures.

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Section: Discussionmentioning

confidence: 99%

Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review

et al. 2018

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“…There are multiple lessons learned in this study that could assist future efforts of implementation and dissemination research in primary care practices. Perhaps the key lesson learned was the need for additional time and resources for practice recruitment, 19,20 a conclusion reached by other EvidenceNOW cooperatives. There is also a need for a longer intense intervention phase where practices have ongoing interaction with external quality improvement specialists, including physician consultants.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care

et al. 2019

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The Heart of Virginia Health care (HVH) was a regional cooperative under the EvidenceNOW initiative to assist primary care practices in implementing evidence-based cardiovascular care and building capacity for quality improvement. The HVH implementation team included individuals from multiple universities, quality improvement organizations, and consulting firms. The goal of this study was to understand HVH team member viewpoints on the challenges, strengths, and lessons learned in each phase of the project. Methods: Qualitative methods were used to facilitate reflection on the implementation and dissemination of the EvidenceNOW initiative in Virginia. In-depth interviews were conducted at the end of the project with 22 HVH team members. A nonparticipant, multidisciplinary research team completed thematic analysis of interview transcripts. Results: Positive attributes of the HVH initiative included diverse team member skills and areas of expertise, a well-received kick-off event, and a comprehensive set of practice improvement resources. Major challenges included recruiting primary care practices, varying types and capabilities of electronic health records, and working with practices at different transformation stages, with different objectives for participating and involvement in other government initiatives. Conclusions: Study findings provide insights for future dissemination research and implementation of evidence-based practices in primary care. Challenges experienced in project development can result in a domino effect that could change the project timeline, type of practices recruited for study participation, resource allocation, and planned activities for quality improvement. Effectiveness of external quality improvement support may depend on practice engagement, preexisting organizational structures and processes, availability of resources, and length and continuity of practice facilitation.

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“…PERCs were a key to recruitment success with EvidenceNOW: 1 in 3 practices had a prior relationship with the organizations enrolled, whereas only 1 in 20 did not. 13 Practices and communities value the sustained relationship, noting that "ORPRN was here yesterday, today and will be with us tomorrow" (personal communication, Lyle Fagnan, MD, 2018). Sustaining these relationships is a major challenge as grants and contracts do not support the need to maintain continuity between projects.…”

Section: Oregon: Practice Enhancement Research Coordinatorsmentioning

confidence: 99%

The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies

et al. 2019

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Passage of the Patient Protection and Affordable Care Act triggered 2 successive grant initiatives from the Agency for Healthcare Research and Quality, allowing for the evolution of health extension models among 20 states, not limited to support for in-clinic primary care practice transformation, but also including a broader concept incorporating technical assistance for practices and their communities to address social determinants of health. Five states stand out in stretching the boundaries of health extension: New Mexico, Oklahoma, Oregon, Colorado, and Washington. Their stories reveal lessons learned regarding the successes and challenges, including the importance of building sustained relationships with practices and community coalitions; of documenting success in broad terms as well as achieving diverse outcomes of meaning to different stakeholders; of understanding that health extension is a function that can be carried out by an individual or group depending on resources; and of being prepared for political struggles over "turf" and ownership of extension. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.

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Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

Cited by 18 publications

References 20 publications

Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review

Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care

The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies

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