Improving prevention in primary care: evaluating the effectiveness of outreach facilitation

Hogg, William; Lemelin, Jacques; Graham, Ian D.; Grimshaw, Jeremy; Martin, Carmel M.; Moore, Linda; Soto, Enio; O’Rourke, Keith

doi:10.1093/fampra/cmm070

Cited by 55 publications

(66 citation statements)

References 12 publications

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“…16 For each patient, we calculated an overall prevention score by dividing the number of manoeuvres performed by the number of manoeuvres for which the patient was eligible within the previous 24 months and then multiplying by 100. For example, for a 55-year-old woman eligible for the three cancer screening manoeuvres, her score would be based on the number of cancer screening manoeuvres performed divided by three and multiplied by 100.…”

Section: Outcome Measuresmentioning

confidence: 99%

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Dahrouge

Hogg

Russell

et al. 2011

CMAJ

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P rimary care providers are increasingly in terested in ensuring that preventive health care be part of their work routines.1 This reorientation fits with the evidence that recommendations from family practitioners increase substantially the likelihood of patients undergoing preventive manoeuvres, 2 whereas the lack of such recommendations has been linked with patient noncompliance. 3,4 Studies evaluating adherence to recommended preventive care suggest that the most pervasive barriers rest with the organization of the health care system and the practice itself, such as the absence of external financial incentives for the work done and the lack of a reminder system in the office. 3,5−9 Countries attempting to reform their delivery of primary care and improve the delivery of preventive services have often directed their efforts in finding alternatives to the traditional fee-forservice model, in which providers receive payment for each service provided. There are two predominant alternative funding models: capitation (pro viders receive a fixed lump-sum payment per pa tient per period, independent of the number of services performed) and salaried remuneration. Some health care systems blend components of fee for service with either of these models or offer additional incentives for reaching defined qualityof-care targets. Despite considerable rhetoric, there is little evidence to point to the remuneration models associated with superior delivery of primary care services. 10 The complexity of health

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Section: Outcome Measuresmentioning

confidence: 99%

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Dahrouge

Hogg

Russell

et al. 2011

CMAJ

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“…6-9 Furthermore, leadership, 10 practice facilitation, 11 and organizational adaptive reserve 12-14 modify a practice's ability to transform. To begin to test large-scale interventions to transform practices, however, a more specifi c description of the process of transformation is necessary.…”

Section: Introductionmentioning

confidence: 99%

“…It is clear that offi ce systems changes are necessary for quality improvement (QI) [1][2][3][4][5] and implementation of the patient-centered medical home (PCMH). [6][7][8][9] Furthermore, leadership, 10 practice facilitation, 11 and organizational adaptive reserve 12-14 modify a practice's ability to transform. To begin to test large-scale interventions to transform practices, however, a more specifi c description of the process of transformation is necessary.…”

mentioning

confidence: 99%

Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model

Donahue

Newton

Lefebvre

et al. 2013

The Annals of Family Medicine

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PURPOSE Practice transformation is the cornerstone of the future of family medicine and health care reform, but little is known about how the process occurs. We sought to develop and test a model of the natural history of practice transformation. METHODSWe developed an outcomes-based model of how a practice moves through practice transformation in 2 phases: (1) initial model created through meetings with collaborative experts and practice facilitators, and (2) clinical and practice systems change reports examined from the fi rst group of participating North Carolina Improving Performance In Practice practices to test and further refi ne the model. RESULTSThe resultant model described motivators and supports to transformation. Three emerging practice patterns were identifi ed with the model: transformed practices experiencing robust improvement, activated practices with moderate change, and engaged practices with minimal change in measured quality over a 2-year period. Transformed practices showed broad-based improvement; some reached a threshold and others continued to improve. These practices had highly engaged leadership and used data to drive decisions. Activated practices had a slower improvement trajectory, usually encountering a barrier that took time to overcome (eg, extracting population data, spreading practice changes). Engaged practices did not improve or were unable to sustain change; despite good intentions, multiple competing distractions interfered with practice transformation. CONCLUSIONS Practice transformation is a continuous and long-term process.Internal and external practice motivations and specifi c practice supports provided by a community-based quality improvement program appear to have an impact on engagement, rate of quality improvement, and long-term sustainability. Early successes play a key role as practices learn how to change their performance. 2013;11:212-219. doi:10.1370/afm.1497. Ann Fam Med INTRODUCTIONP ractice transformation on a large scale is a cornerstone of the future of family medicine and health care reform, but little is known about the natural history of the process. It is clear that offi ce systems changes are necessary for quality improvement (QI) [1][2][3][4][5] and implementation of the patient-centered medical home (PCMH). [6][7][8][9] Furthermore, leadership, 10 practice facilitation, 11 and organizational adaptive reserve 12-14 modify a practice's ability to transform. To begin to test large-scale interventions to transform practices, however, a more specifi c description of the process of transformation is necessary.Prior work suggests that the methods for changing offi ce systems for chronic disease 4 18 This program strives to improve clinical outcomes with the use of practice facilitators and other interventions to help practices to improve care delivery through changes in offi ce systems. The assumptions of this program are that practices, rather than individuals, are the key units of delivery of primary care, and that offi ce systems drive much o...

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“…17 Another meta-analytic review found practices receiving PF were three times as likely as control practices to implement guidelines. 18 Studies also found the effects from PF to be sustained for as long as 12 months postintervention, [19][20][21][22] with evidence of costeffectiveness. 23 However, it remains unknown whether the effects of PF focused on using QI methods impacts clinical process measures in rural clinics caring for patients with chronic pain.…”

mentioning

confidence: 99%

Improving Chronic Pain Management Processes in Primary Care Using Practice Facilitation and Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative

Cardarelli

Weatherford

Schilling

et al. 2017

Journal of Patient-Centered Research and Reviews

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Improving prevention in primary care: evaluating the effectiveness of outreach facilitation

Cited by 55 publications

References 12 publications

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model

Improving Chronic Pain Management Processes in Primary Care Using Practice Facilitation and Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative

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