TY - JOUR 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 SP - 1115 LP - 1127 DO - 10.3122/jabfm.2022.220088R1 VL - 35 IS - 6 AU - Deborah J. Cohen AU - Bijal A. Balasubramanian AU - Stephan Lindner AU - William L. Miller AU - Shannon M. Sweeney AU - Jennifer D. Hall AU - Rikki Ward AU - Miguel Marino AU - Rachel Springer AU - K. John McConnell AU - Jennifer R. Hemler AU - Sarah S. Ono AU - David Ezekiel-Herrera AU - Andrea Baron AU - Benjamin F. Crabtree AU - Leif I. Solberg Y1 - 2022/12/23 UR - http://www.jabfm.org/content/35/6/1115.abstract N2 - 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. ER -