Building a Learning Health Care Organization: External Facilitation Tailors Support to the Learning Capacity of Primary Care Settings

Parchman, Michael L.; Hsu, Clarissa; Fagnan, Lyle J.; Borkulo, Nicole Van; Tuzzio, Leah

doi:10.17294/2330-0698.1547

Cited by 5 publications

(6 citation 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: 98%

“…Coordinating these 2 projects will also allow us to study the outcomes of importance for both ECHO and practice transformation. 1,26 Financial Stability Currently, PBRNs struggle financially. 1,13,14 Early sources of infrastructure support from Agency for Health care Research and Quality and occasionally Clinical and Translational Science Awards are now rare.…”

Section: Diabetes Managementmentioning

confidence: 99%

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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: 98%

Section: Diabetes Managementmentioning

confidence: 99%

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

et al. 2020

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“…Our study bridges improvement science, implementation science, and participatory methods, allowing for local change and the production of generalizable knowledge [ 18 , 61 ]. The mixed-methods analysis will advance our understanding supporting program implementation across diverse primary care contexts and how practice facilitators tailor implementation support to context over time [ 14 , 43 , 62 ]. ANTECEDENT intervention activities commenced in February 2020, just before multiple changes in clinical practice and research protocols in response to the COVID-19 pandemic [ 63 – 65 ].…”

Section: Discussionmentioning

confidence: 99%

Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study

Singh

Sánchez²,

Kenzie³

et al. 2022

PLoS ONE

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Background Unhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care. Methods ANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center—state leaders in Medicaid health system transformation—SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework. Discussion This study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.

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“…This assistance is reflected in the finding that the baseline QICA score was predictive of both the number and the types of topics discussed. 37 For follow-up scores, facilitators were asked if they agreed with the practice's self-scores, specifically, that the scores accurately reflected externally observable changes in care processes; most agreed. In addition, changes in the HLC subscores were greatest for the HLCs where the facilitators focused most of their time and effort, which increases confidence that the tool is measuring real improvements.…”

Section: Discussionmentioning

confidence: 99%

Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices

et al. 2021

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Building a Learning Health Care Organization: External Facilitation Tailors Support to the Learning Capacity of Primary Care Settings

Cited by 5 publications

References 0 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)

Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study

Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices

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