Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings

Baskerville, Bruce; Liddy, Clare; Hogg, William

doi:10.1370/afm.1312

Cited by 420 publications

(495 citation statements)

References 80 publications

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“…As shown by our group and by others, tailored practice facilitation for QI and EHR support works [20][21][22]. At the very least, practices could update their EHR capabilities, get help with data analytics, and receive assistance in developing advanced workflows and protocols that align with fresh evidence and best practices.…”

Section: Discussionmentioning

confidence: 86%

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

Cykert

Lefebvre

Bacon

et al. 2016

North Carolina Medical Journal

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background The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness of such a program-similar to an agricultural extension center model-that provides these services. methods Through the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act, the North Carolina Area Health Education Centers program became the Regional Extension Center for Health Information Technology (REC) for North Carolina. The REC program provides onsite technical assistance to help small primary care practices achieve meaningful use of certified EHRs. While pursuing meaningful use functionality, practices were also offered complementary onsite advice regarding QI issues. We followed the first 50 primary care practices that utilized both EHR and QI advice targeting diabetes care. results The achievement of meaningful use of certified EHRs and performance of QI with onsite practice facilitation showed an absolute improvement of 19% in the proportion of patients who achieved excellent diabetes control (hemoglobin A1c < 7%) compared to baseline. In addition, the percentages of patients with poorly controlled diabetes (hemoglobin A1c > 9%) fell steeply in these practices. limitations No control group was available for comparison. conclusion Practice facilitation that provided EHR and QI coaching support showed important improvements in diabetes outcomes in practices that achieved meaningful use of their EHR systems. This approach holds promise as a way to help small primary care practices achieve excellent patient outcomes.

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Section: Discussionmentioning

confidence: 86%

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

Cykert

Lefebvre

Bacon

et al. 2016

North Carolina Medical Journal

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“…31,66,67 Previous studies have not described practice-specific characteristics associated with improvement. 34,61,65 Our PTFI program led to large improvements in all 3 services: obesity detection/ counseling, lead screening, and fluoride application. Most improvements were broad-based with no difference in improvement across practices with different characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…The intervention was based on principles of practice-tailored facilitation 13,26,30,34 and rapid-cycle change. 13,18,24,31,[49][50][51][52] Practice facilitation recognizes that imposed mandates for change are not likely to be sustained, and that incorporation of evidence-based practice requires tailoring an intervention based on individual practice needs.…”

Section: Interventionmentioning

confidence: 99%

“…[23][24][25] Practice change facilitation implements interventions tailored to the needs of individual practices and, especially when combined with academic detailing and rapid-cycle feedback, has been shown to improve delivery of primary care-based preventive services 26,27 ; although experience with pediatric services is more limited, 24,26,[28][29][30][31][32][33][34] and insights into how effective facilitation actually works are also limited. [34][35][36] We implemented and evaluated a 6-month Practice-Tailored Facilitation Intervention (PTFI), called CHEC-UPPP (Child Health Excellence Center: a UniversityPractice-Public Partnership), that combines practice coaching with rapid-cycle feedback/change to improve delivery of recommended pediatric preventive services simultaneously in 3 domains of public health importance: obesity detection and counseling, lead screening, and fluoride varnish application to prevent dental decay, targeting diverse practice settings. 11,[37][38][39][40][41] We also sought to characterize the process by which the facilitation approach can be successfully adjusted to meet diverse practices' learning styles and levels of need.…”

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confidence: 99%

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Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children receive only half of recommended health care; disadvantaged children have higher risk of unmet needs. Practice coaching combined with quality improvement using rapid-cycle feedback has potential to help practices meet quality standards and improve pediatric health care delivery. WHAT THIS STUDY ADDS:The Practice-tailored Facilitation Intervention led to large and sustained improvements in preventive service delivery, including substantial numbers of disadvantaged children, and in multiple simultaneous health care domains. Practice-tailored facilitation holds promise as a method to advance pediatric preventive care delivery. abstract OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS:In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS:Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: ,0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P , .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P , .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.

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“…48,[52][53][54] Our hypothesis-generating findings suggested clinical staff may not have been systematically trained to conduct alcohol screening, and may be not be aware that screening should identify patients with risky drinking in addition to those with alcohol use disorders. [55][56][57] User-level training strategies, such as didactic training, academic detailing, clinical champions, or practice facilitation 58,59 may be necessary in order to convey risks associated with the entire spectrum of unhealthy alcohol use (including risky drinking), and the reason for identifying patients with the spectrum of unhealthy alcohol use (i.e., the efficacy of brief intervention).…”

Section: Reports Of Adapting Screening To Enhance Patient Comfortmentioning

confidence: 99%

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

et al. 2015

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Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings

Abstract: Practice facilitation has a moderately robust effect on evidence-based guideline adoption within primary care. Implementation fidelity factors, such as tailoring, the number of practices per facilitator, and the intensity of the intervention, have important resource implications.

Cited by 420 publications

References 80 publications

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

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