Table 1.

Qualitative Descriptions of Cooperative Partnerships in Building Facilitation Workforces

RegionLeadershipOrganization Background and experience providing facilitation support
NorthwestMacColl Center for Health Care Innovation at Kaiser Permanente Washington Health Research InstituteWashington and Idaho
  • QIN-QIO and REC, helping practices with HIT.

  • PFs previously worked with practices on EHR adoption and MU, as well as other types of QI initiatives.

  • PBRN with a history of working with practices on research and QI.

  • Partnered with HIT experts to provide HIT support.

VirginiaVirginia Commonwealth University
  • REC for VA and holds the QIO contract for VA and MD.

  • PFs experienced in working with regional primary care practices. Emphasis of previous work was on EHR optimization, through a number of federal programs.

  • Provided facilitation support to all practices except one large health system that used internal PFs.

North CarolinaUniversity of North Carolina, Chapel Hill
  • AHEC with long history in the region; experienced in developing primary care infrastructure and working with primary care practices on QI and practice redesign initiatives.

  • Became the state’s REC and began getting more involved in helping practices optimize use of the EHR.

  • Staffs its PF workforce through a connected infrastructure of nine regional AHEC centers throughout the state. PFs are experienced in at least one of three areas – QI, data acquisition and reporting, or systems implementation and redesign – and work together to provide full-support to practices.

New York CityNew York UniversityREC
  • Long history of working with small, independent practices.

  • Initially assisted practices with EHR adoption and technical assistance. Now also provide services supporting PCMH recognition.

  • Many PFs had previous relationships with practices and were able to quickly engage and support practices, particularly through technical support.

Primary Care Association
  • 501(c)(3) non-profit receiving funding through grants for community health centers across the state. Only worked with NYC-area FQHCs on EN.

  • Previously worked with practices primarily through learning collaboratives and built their knowledge of practice facilitation and their PF workforce.

MidwestNorthwestern University
  • Seven organizations across the tri-state region provided support to EN practices in the Midwest. These organizations had varying roles and experience providing facilitation before EN, and varying levels of familiarity working with each other.

  • Health Center Controlled Network that had previously worked with community health centers on QI projects.

  • Non-profit previously participating in QI research studies, developed the curriculum and led the PF training.

  • REC that previously worked with practices on MU.

  • REC that previously assisted practices with MU and QI goals.

  • QIO that previously assisted practices with EHR implementation, performance improvement and PQRS measurements.

  • REC that previously provided HIT consulting and QI services.

  • REC and QIO that assisted practices with EHR adoption and QI.

OklahomaUniversity of Oklahoma
  • PF workforce builds on previous decades of work. This work was cultivated through work on past initiatives such as IMPaCT, PCMH and CPC.

  • PFs were housed at the university and at the region’s QIO and REC.

  • Those at the QIO/REC and had more HIT experience, and previously supported practices with MU.

  • QIO/REC also provided technical assistance to practices for HIT assistance.

SouthwestUniversity of Colorado University of New MexicoColorado:
  • Organizations consisted of RECs, QIN-QIOs, PBRNs, integrated health networks and health systems. Organizations have varied experience with providing PF support. One is a well-known PF organization and has trained PFs from other organizations for over a decade. Some organizations had previous relationships with their practices, and some did not.

  • Most PFs assisted practices with practice redesign and QI. PFs with fewer technical skills partnered with someone with HIT skills, while others served as both the PF and worked on HIT with the practice.

New Mexico:
  • QIO previously assisted private practices with QI for Medicare and CMMI.

  • Nonprofit Association previously worked with FQHCs on QI projects.

  • Both organizations were contractors for New Mexico’s REC. Their PFs have HIT expertise and served as both PFs and worked on HIT.

  • EN, EvidenceNOW; REC, regional extension center; QIN-QIO, quality improvement network–quality improvement organization; PBRN, practice-based research network; MU, meaningful use; FQHC, federally quality health centers; EHR, electronic health record; QI, quality improvement; HIT, health information technology; PCMH, primary care medical home; PF, practice facilitator; AHEC, Area Health Education Center; CMMI, Center for Medicare & Medicaid Innovation; CPC, Comprehensive Primary Care Initiative; VA, Virginia; MD, Maryland; IMPaCT, Infrastructure for Maintaining Primary Care Transformation.