Article Figures & Data
Figures
- Figure 1.
Domain and Agent Relationships.
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Domain Definition Example Conceptual model Models used to conceptualize the care process, change process, outcomes, and changes at the practice, team, and individual levels that are hypothesized to influence outcomes Choosing to base support targets on the Chronic Care Model25 would require consideration of changes in its domains (decision support, clinical information system, etc), but would provide no guidance for how to facilitate those changes Support strategies Methods or techniques used by practice change support agents to motivate, guide, and support practices in adopting, implementing, and sustaining evidence-based changes and quality improvements Although practice facilitation was the main strategy used by all of the EvidenceNOW grantees, all also included data support and audit with feedback and some used education and training Care change focus The establishment of a priority regarding what care processes will be targets for improvement Some grantees encouraged trying to improve care processes for all four EN targets (aspirin, blood pressure, cholesterol, and smoking) while others left the focus up to individual practices Change process The method of guiding change through ongoing support activities to help implement innovations, create efficiency, or improve outcomes The model for improvement26 provides a framework for change by asking a change team to answer 3 questions and then conduct rapid cycle test of change Prescriptivity The extent to which practices are expected to make pre-specified changes and then are assessed on the degree to which they make those changes Generally, only government entities can mandate that practices make specific changes and have the ability to require them Standardization The degree to which an external agent provides support in a standardized way for all practices participating in an initiative The DIAMOND initiative27 to implement collaborative care for depression provided the same training and support options for all practices Dose/mode A measure of practice support that accounts for exposure (number of contacts), intensity (total contact time), reach (practice members involved and their level of influence), engagement (commitment and effort), duration (total time over which support occurred) and mode (proportion of contacts that occur in person vs other forms of communication) EN grantees used various methods for facilitators to track the number, duration, and type of interactions with the practices they were assisting DIAMOND, name of a statewide initiative to improve depression care in MN; EHR, electronic health record; EN, EvidenceNOW; IT, information technology; LtOT, long-term opioid therapy; MED, morphine-equivalent dose.
