Enhancing Collaborative Learning for Quality Improvement: Evidence from the Improving Clinical Flow Project, a Breakthrough Series Collaborative with Project ECHO

Arora, Sanjeev; Mate, Kedar S.; Jones, Jessica L.; Sevin, Cory; Clewett, Elizabeth; Langley, G. Curtis; Brakey, Heidi Rishel; Reims, Kathleen; Troyer, Judy L.; Grebe, Joan M.; Davis, Herbert; Wolfe, Venita K.; Chaufournier, Roger; Baker, Neil

doi:10.1016/j.jcjq.2020.04.013

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…While part of a single health system, the ability of the collaborative to reach across a diversity of practices suggests the principals applied here could be adopted among other primary care groups. 8 , 18 , 36 The collaborative achieved early success for many reasons, among them inclusivity, strong identification with community-based clinicians, and an intentionally diverse SC. While many academic departments struggle to engage physicians in their communities with scholarly activity, those associated with this collaborative were able to do so.…”

Section: Discussionmentioning

confidence: 99%

Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System

Erickson

Dabrh

Chavez

et al. 2022

J Prim Care Community Health

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Introduction: Primary care clinicians are presented with hundreds of new clinical recommendations and guidelines. To consider practice change clinicians must identify relevant information and develop a contextual framework. Too much attention to information irrelevant to one’s practice results in wasted resources. Too little results in care gaps. A small group of primary care clinicians in a large health system sought to address the problem of vetting new information and providing peer reviewed context. This was done by engaging colleagues across the system though a primary care learning collaborative. Methods: The collaborative was a grass roots initiative between community and academic-based clinicians. They invited all the system’s primary care clinicians to participate. They selected new recommendations or guidelines and used surveys as the principal communication instrument. Surveys shared practice experience and also invited members to give narrative feedback regarding their acceptance of variation in care relate to the topic. A description of the collaborative along with its development, processes, and evolution are discussed. Process changes to address needs during the COVID-19 pandemic including expanded information sharing was necessary. Results: Collaborative membership reached across 5 states and included family medicine, internal medicine, and pediatrics. Members found involvement with the collaborative useful. Less variation in care was thought important for public health crises: the COVID pandemic and opioid epidemic. Greater practice variation was thought acceptable for adherence to multispecialty guidelines, such as diabetes, lipid management, and adult ADHD care. Process changes during the pandemic resulted in more communications between members to avoid practice gaps. Conclusion: An internet-based learning collaborative in a health system had good engagement from its members. Using novel methods, it was able to provide members with feedback related to the importance of new practice recommendations as perceived by their peers. Greater standardization was thought necessary when adopting measures to address public health crisis, and less necessary when addressing multispecialty guidelines. By employing a learning collaborative, this group was able to keep members interested and engaged. During the first year of the COVID pandemic the collaborative also served as a vehicle to share timely information.

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Section: Discussionmentioning

confidence: 99%

Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System

Erickson

Dabrh

Chavez

et al. 2022

J Prim Care Community Health

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“…This knowledge will be documented in change packages that include a clear description of the strategy, the indicators used to evaluate its impact, lessons learned and a sustainability plan [ 60 ]. These packages have been reported as being highly valuable in supporting organisational change [ 63 , 82 ]. Group mentoring will aim to increase the effectiveness of the QI coach’s follow-ups and to optimise knowledge transfer of AA improvement strategies among clinics.…”

Section: Methodsmentioning

confidence: 99%

Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial

et al. 2023

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Background Improving access to primary health care is among top priorities for many countries. Advanced Access (AA) is one of the most recommended models to improve timely access to care. Over the past 15 years, the AA model has been implemented in Canada, but the implementation of AA varies substantially among providers and clinics. Continuous quality improvement (CQI) approaches can be used to promote organizational change like AA implementation. While CQI fosters the adoption of evidence-based practices, knowledge gaps remain, about the mechanisms by which QI happens and the sustainability of the results. The general aim of the study is to analyse the implementation and effects of CQI cohorts on AA for primary care clinics. Specific objectives are: 1) Analyse the process of implementing CQI cohorts to support PHC clinics in their improvement of AA. 2) Document and compare structural organisational changes and processes of care with respect to AA within study groups (intervention and control). 3) Assess the effectiveness of CQI cohorts on AA outcomes. 4) Appreciate the sustainability of the intervention for AA processes, organisational changes and outcomes. Methods Cluster-controlled trial allowing for a comprehensive and rigorous evaluation of the proposed intervention 48 multidisciplinary primary care clinics will be recruited to participate. 24 Clinics from the intervention regions will receive the CQI intervention for 18 months including three activities carried out iteratively until the clinic’s improvement objectives are achieved: 1) reflective sessions and problem priorisation; 2) plan-do-study-act cycles; and 3) group mentoring. Clinics located in the control regions will receive an audit-feedback report on access. Complementary qualitative and quantitative data reflecting the quintuple aim will be collected over a period of 36 months. Results This research will contribute to filling the gap in the generalizability of CQI interventions and accelerate the spread of effective AA improvement strategies while strengthening local QI culture within clinics. This research will have a direct impact on patients’ experiences of care. Conclusion This mixed-method approach offers a unique opportunity to contribute to the scientific literature on large-scale CQI cohorts to improve AA in primary care teams and to better understand the processes of CQI. Trial registration Clinical Trials: NCT05715151.

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“…Implementation of the ECHO model also serves as an opportunity to leverage quality improvement (QI) projects for community clinics and clinicians. [54][55][56] In California and Florida, a multi-site diabetes QI initiative leveraging the model demonstrated vast improvements across structural, process, and outcome measures. 57 Examples of measures demonstrating improvement included clinic having a protocol of identifying "high risk" patients and enrolling them in special care pathways, clinic having a workflow for scheduling "lost to follow-up patients," number of CGM prescriptions submitted last quarter, number and/or percentage of patients whose most recent A1c was greater than 9%, mean A1c of patients of most recent A1c for the current measurement year for both commercial insurance and Medicaid.…”

Section: Addressing Quality Improvement Practicesmentioning

confidence: 99%

Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities

Ehrhardt

Bouchonville

Peek

et al. 2023

J Diabetes Sci Technol

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Project ECHO® is a telementoring workforce development model that targets under-resourced communities lacking access to specialty care. The model builds virtual communities of practice, including specialists and community primary care professionals (PCPs) to combat clinical inertia and health disparities. While the ECHO model has gained global recognition, implementation of the model related to diabetes is lagging compared to other specialty conditions. This review highlights diabetes-endocrine (ENDO)-focused ECHOs using data reported in the ECHO Institute’s centralized data repository (iECHO) and the learning collaborative for diabetes ECHOs. It also describes the implementation of diabetes ECHOs and their evaluation. Learner and patient-centered outcomes related to diabetes ECHOs are reviewed. Program implementation and evaluations have demonstrated utility of the ECHO model for diabetes programs to (1) address unmet needs of diabetes care in the primary care setting, (2) improve knowledge and confidence in managing complex diabetes and change provider prescribing habits, (3) improve patient outcomes, and (4) address diabetes quality improvement practices in primary care. More studies with broader collaboration among sites are needed to evaluate the model related to diabetes, especially applied to addressing therapeutic inertia, adoption of diabetes technology, and reducing health disparities.

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Enhancing Collaborative Learning for Quality Improvement: Evidence from the Improving Clinical Flow Project, a Breakthrough Series Collaborative with Project ECHO

Cited by 15 publications

References 19 publications

Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System

Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System

Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial

Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities

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