RT Journal Article
SR Electronic
T1 How Does Prior Experience Pay Off in Large-Scale Quality Improvement Initiatives?
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 1115
OP 1127
DO 10.3122/jabfm.2022.220088R1
VO 35
IS 6
A1 Deborah J. Cohen
A1 Bijal A. Balasubramanian
A1 Stephan Lindner
A1 William L. Miller
A1 Shannon M. Sweeney
A1 Jennifer D. Hall
A1 Rikki Ward
A1 Miguel Marino
A1 Rachel Springer
A1 K. John McConnell
A1 Jennifer R. Hemler
A1 Sarah S. Ono
A1 David Ezekiel-Herrera
A1 Andrea Baron
A1 Benjamin F. Crabtree
A1 Leif I. Solberg
YR 2022
UL http://www.jabfm.org/content/35/6/1115.abstract
AB Introduction: To examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care.Methods: Mixed-methods study of 7 EvidenceNOW grantees (henceforth, Cooperatives) and their recruited practices (n = 1720). Independent Variable: Cooperatives’s experience level prior to EvidenceNOW, defined as a sustained track record in delivering large-scale quality improvement (QI) to primary care practices (high, medium, or low). Dependent Variables: Implementation of external support, measured as facilitation dose; effectiveness at improving (1) clinical quality, measured as practices’ performance on Aspirin, Blood Pressure, Cholesterol, and Smoking (ABCS); and (2) practice capacity, measured using the Adaptive Reserve (AR) score and Change Process Capacity Questionnaire (CPCQ). Data were analyzed using multivariable linear regressions and a qualitative inductive approach.Results: Cooperatives with High (vs low) levels of prior experience with and investment in large-scale QI before EvidenceNOW recruited more geographically dispersed and diverse practices, with lower baseline ABCS performance (differences ranging from 2.8% for blood pressure to 41.5% for smoking), delivered more facilitation (mean=+20.3 hours, P = .04), and made greater improvements in practices’ QI capacity (CPCQ: +2.04, P < .001) and smoking performance (+6.43%, P = .003). These Cooperatives had established networks of facilitators at the start of EvidenceNOW and leadership experienced in supporting this workforce, which explained their better recruitment, delivery of facilitation, and improvement in outcomes.Discussion: Long-term investment that establishes regionwide organizations with infrastructure and experience to support primary care practices in QI is associated with more consistent delivery of facilitation support, and greater improvement in practice capacity and some clinical outcomes.