Kent F. Sutton, BA; Erica L. Richman, PhD, MSW; Jennifer R. Rees, RN, CPF; Liza L. Pugh-Nicholson, MSM; Macie M. Craft, RN, MSN, CPF; Shannon H. Peaden, MBA, CPF; Monique Mackey, MLS; Jacqueline R. Halladay, MD, MPH; Southeastern Collaboration to Improve Blood Pressure Workgroup
Corresponding Author: Erica L. Richman, PhD, MSW; University of North Carolina at Chapel Hill - Cecil G. Sheps Center for Health Services Research. Email: elr@email.unc.edu
Section: Original Research
Publication: September 16, 2021
Background: Practice facilitation (PF) is a promising but relatively new intervention supporting data driven practice change. There is a need to better detail research-based facilitation methods which must balance intervention fidelity and time restrictions with the flexibility required for the intervention. As part of a multi-level 4-armed cluster RCT, 32 rural primary care practices received PF for one year. We evaluated the feasibility of having facilitators guide practices to perform 4 key driver domain activities, implemented as Plan-Do-Study-Act (PDSA) cycles, to better understand facilitation “exposure”. We describe the intervention and activity length such that our experiences may be useful to other PF research efforts. Methods: 32 practices serving rural patients involved in the Southeastern Collaboration to Improvement Blood Pressure Control engaged with a facilitator to develop and implement PDSAs nested within key drivers of change domains. Numbers of months practices worked on activities deemed most likely to be sustained were captured along with practice satisfaction data. Results: All practices engaged in at least 4 domain level activities and 59% of the PDSAs were active for at least 3 months. There was variation by domain in the average length of the PDSA activities. 97% (31/32) of practices recommended similarly structured facilitation services to other primary care practices and 27/32 noted substantive changes in their care processes. Conclusion: In this trial it was feasible for PFs to engage practices in at least 4 Key Driver quality improvement activities within one year which will inform PF methods and protocol development in future trials.