RT Journal Article
SR Electronic
T1 Identifying Practice Facilitation Delays and Barriers in Primary Care Quality Improvement
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 655
OP 664
DO 10.3122/jabfm.2020.05.200058
VO 33
IS 5
A1 Jiancheng Ye
A1 Renwen Zhang
A1 Jennifer E. Bannon
A1 Ann A. Wang
A1 Theresa L. Walunas
A1 Abel N. Kho
A1 Nicholas D. Soulakis
YR 2020
UL http://www.jabfm.org/content/33/5/655.abstract
AB Objective: Practice facilitation is an effective approach to implementing quality improvement (QI) interventions in practice-based research networks (PBRNs). Regular facilitator-practice interactions are necessary for successful facilitation, and missed engagements may hinder the process of practice improvement. This study employs a mixed-methods approach to characterize the dynamics of practice facilitation and examine facilitation delays and barriers, as well as their association with the achievement of QI program goals in a PBRN initiative.Methods: This study presents a secondary analysis of data from 226 primary care practices that participated in the Healthy Hearts in the Heartland (H3) initiative. We performed a time series analysis to identify delays in facilitation activities, and then qualitatively analyzed practice facilitators' notes (n = 4358) to uncover facilitation barriers. Finally, we assessed the relationship between delays, barriers, and QI intervention completion.Results: While most facilitation activities occurred at regular, practice-specific tempos, nearly all practices experienced at least 1 delay. Practices with more delays had lower QI intervention completion rates. Practices with more delays were more likely to have encountered barriers such as lack of time and staff, lack of staff engagement, technical issues, and staff turnover.Discussion and Conclusion: This study is the first to quantify irregular intervals between facilitation activities and demonstrate their negative association with project completion. The analytic method can be applied to identify at-risk practices and to accelerate timely interventions in future studies. Our delay detection algorithm could inform the design of a decision support system that notifies facilitators which practices may benefit from timely attention and resources.