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

Coleman, Katie; Krakauer, Chloe; Anderson, Melissa; Michaels, LeAnn; Dorr, David A.; Fagnan, Lyle J.; Hsu, Clarissa; Parchman, Michael L.

doi:10.1370/afm.2733

Cited by 4 publications

(3 citation statements)

References 35 publications

(35 reference statements)

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“…The primary outcomes of this study and a detailed description of the facilitator intervention have been previously published. 10,15 To guide the facilitator in supporting the practice in extracting and reporting CQM measures from the EHR, 2 of the authors (JH, RH) developed a rapid assessment of the 3 domains previously described: leadership support, EHR reporting capabilities, and staff skills for reporting. A relevant description of each domain was written, with input from the facilitators, along with a 3-level response: basic, intermediate, or advanced.…”

Section: Methodsmentioning

confidence: 99%

“…4,9 Assessing and strengthening these domains may be a potentially promising strategy to increase a practice's capacity to improve the quality of care it delivers. 10 The purpose of this study is to describe the results of an assessment of the above 3 domains and their associations with successful CQM reporting during an initiative to improve smaller primary care practices' cardiovascular disease (CVD) risk reduction efforts.…”

Section: Introductionmentioning

confidence: 99%

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The Ability of Primary Care Practices to Measure and Report on Care Quality

Parchman,

Baldwin,

Howell

et al. 2024

J Am Board Fam Med

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Background: Creating useful clinical quality measure (CQM) reports in a busy primary care practice is known to depend on the capability of the electronic health record (EHR). Two other domains may also contribute: supportive leadership to prioritize the work and commit the necessary resources, and individuals with the necessary health information technology (IT) skills to do so. Here we describe the results of an assessment of the above 3 domains and their associations with successful CQM reporting during an initiative to improve smaller primary care practices' cardiovascular disease CQMs.Methods: The study took place within an AHRQ EvidenceNOW initiative of external support for smaller practices across Washington, Oregon and Idaho. Practice facilitators who provided this support completed an assessment of the 3 domains previously described for each of their assigned practices. Practices submitted 3 CQMs to the study team: appropriate aspirin prescribing, use of statins when indicated, blood pressure control, and tobacco screening/cessation.Results: Practices with advanced EHR reporting capability were more likely to report 2 or more CQMs. Only one-third of practices were "advanced" in this domain, and this domain had the highest proportion of practices (39.1%) assessed as "basic." The presence of advanced leadership or advanced skills did not appreciably increase the proportion of practices that reported 2 or more CQMs.Conclusions: Our findings support previous reports of limited EHR reporting capabilities within smaller practices but extend these findings by demonstrating that practices with advanced capabilities in this domain are more likely to produce CQM reports.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Ability of Primary Care Practices to Measure and Report on Care Quality

Parchman,

Baldwin,

Howell

et al. 2024

J Am Board Fam Med

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show abstract

“…7 Research suggests that facilitation can be effective [8][9][10] and that use of facilitators is growing, 5 as policies and guidelines affecting primary care rapidly change. 11 Studies suggest that facilitators use varied interpersonal communication and health information technology skills to help practices make incremental process improvements, 9,[12][13][14][15] and facilitators benefit from training and other supportive structures, including peer support. 16 Research examining the strategies facilitators use that contribute to organizational change and clinical outcome improvement, [17][18][19] which would benefit the change management field more broadly, is limited.…”

mentioning

confidence: 99%

Effective Facilitator Strategies for Supporting Primary Care Practice Change: A Mixed Methods Study

et al. 2022

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PURPOSE Practice facilitation is an evidence-informed implementation strategy to support quality improvement (QI) and aid practices in aligning with best evidence. Few studies, particularly of this size and scope, identify strategies that contribute to facilitator effectiveness. METHODSWe conducted a sequential mixed methods study, analyzing data from Eviden-ceNOW, a large-scale QI initiative. Seven regional cooperatives employed 162 facilitators to work with 1,630 small or medium-sized primary care practices. Main analyses were based on facilitators who worked with at least 4 practices. Facilitators were defined as more effective if at least 75% of their practices improved on at least 1 outcome measure-aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity, measured using Change Process Capability Questionnaire-from baseline to follow-up. Facilitators were defined as less effective if less than 50% of their practices improved on these outcomes. Using an immersion crystallization and comparative approach, we analyzed observational and interview data to identify strategies associated with more effective facilitators. RESULTSPractices working with more effective facilitators had a 3.6% greater change in the mean percentage of patients meeting the composite ABS measure compared with practices working with less effective facilitators (P <.001). More effective facilitators cultivated motivation by tailoring QI work and addressing resistance, guided practices to think critically, and provided accountability to support change, using these strategies in combination. They were able to describe their work in detail. In contrast, less effective facilitators seldom used these strategies and described their work in general terms. Facilitator background, experience, and work on documentation did not differentiate between more and less effective facilitators.CONCLUSIONS Facilitation strategies that differentiate more and less effective facilitators have implications for enhancing facilitator development and training, and can assist all facilitators to more effectively support practice changes.

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Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

Bam,

Olaiya,

Cadilhac

et al. 2024

PLoS ONE

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Background Primary care is usually the entry point for preventing cardiovascular disease (CVD). Quality indicators can be used to assess and monitor the quality of care provided in a primary care setting. In this systematic review, we aimed to identify, summarise, and assess the methodological quality of indicators reported in the articles for the primary prevention of CVD in primary care. Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, SCOPUS, and grey literature for articles containing quality indicators published in English language. Quality indicators were categorised using the Donabedian framework: Structure (organisation of care), Process (assessment of metabolic risk factors, global risk assessment, lifestyle management, prescription of medications, risk communication/advice, referral), and Outcome (attainment of risk factor targets). Articles were reviewed by two authors, using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, where a score of ≥50% for each domain indicated strong methodological quality (e.g., stakeholder involvement). Results We identified 282 articles for full-text review; 57 articles were included for extraction. A total of 726 (681 unique) quality indicators were extracted. Three out of four (76%) were process indicators (56 articles), followed by 15% outcome indicators (40 articles), and 9% structure indicators (12 articles). One-third of process indicators were related to the assessment of metabolic risk factors (222/726 indicators, 41 articles), followed by lifestyle management (153/726 indicators, 39 articles), prescription of medications (122/726 indicators, 37 articles), and global risk assessment (27/726, 14 articles). Few indicators were related to risk communication/advice (20/726 indicators, 7 articles) and referral (9/726 indicators, 6 articles). Only 26/57 (46%) articles were found to have strong methodological quality. Conclusion We summarised and appraised the methodological quality of indicators for the primary prevention of CVD. The next step requires prioritising a minimum set of quality indicators to encourage standardised collection and monitoring across countries.

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

Cited by 4 publications

References 35 publications

The Ability of Primary Care Practices to Measure and Report on Care Quality

The Ability of Primary Care Practices to Measure and Report on Care Quality

Effective Facilitator Strategies for Supporting Primary Care Practice Change: A Mixed Methods Study

Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

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