Michaels LeAnn, Anastas Tracy, Waddell Elizabeth Needham, Fagnan Lyle, Dorr David A
From the Oregon Health & Science University, Portland, OR
From the Oregon Health & Science University, Portland, OR.
J Am Board Fam Med. 2017 Sep-Oct;30(5):572-582. doi: 10.3122/jabfm.2017.05.170013.
To understand how focused versus general practice facilitation can impact goal setting, action planning, and team performance in primary care transformation.
Practice transformation in primary care is a crucial part of health reform, but can fatigue teams, leading to variable results. Practice facilitation may reduce primary care fatigue to help teams reach challenging transformation goals, but may require a more focused approach than previous studies suggest.
We performed a 12-month cluster randomized trial, during which 8 primary care clinics received practice facilitation. Four practices in the intervention arm received targeted facilitation to focus quality improvement (QI) goals on high-value elements (HVEs) intended to reduce cost and utilization, whereas 4 control practices received generalized QI facilitation. We investigated the impact of the targeted versus generalized approach on goal selection, action item selection and achievement, HVE attainment, and collaborative practice, using quantitative and qualitative methods.
Intervention clinics selected an average of 7 goals and 29 action items, compared with 8 goals and 40 action items among controls. Eighty-three percent of intervention goals were related to HVEs, compared with 27% of goals among controls. Intervention clinics selected 101 HVE goals and met 68%, while controls selected 41 and met 61%. Analysis of pre-post practice surveys indicated greater improvement among intervention across 4 of 8 domains of collaborative practice.
Targeted facilitation may be more effective than a generalized approach to support practices in reaching high-value change goals, as well as fostering improvement of team focus on goals, roles and responsibilities.
了解针对性实践促进与一般性实践促进如何影响初级保健转型中的目标设定、行动计划制定和团队绩效。
初级保健中的实践转型是医疗改革的关键部分，但可能使团队疲惫不堪，导致结果参差不齐。实践促进可能会减轻初级保健疲劳，帮助团队实现具有挑战性的转型目标，但可能需要一种比以往研究建议的更具针对性的方法。
我们进行了一项为期12个月的整群随机试验，在此期间，8家初级保健诊所接受了实践促进。干预组的4家诊所接受了针对性促进，将质量改进（QI）目标聚焦于旨在降低成本和利用率的高价值要素（HVE），而4家对照诊所接受了一般性QI促进。我们使用定量和定性方法研究了针对性方法与一般性方法对目标选择、行动项目选择与达成、HVE实现以及协作实践的影响。
干预组诊所平均选择了7个目标和29个行动项目，而对照组分别为8个目标和40个行动项目。干预组83%的目标与HVE相关，而对照组这一比例为27%。干预组诊所选择了101个HVE目标并实现了68%，而对照组选择了41个并实现了61%。对实践前后调查的分析表明，在协作实践的8个领域中的4个领域，干预组的改善更大。
在支持实践实现高价值变革目标以及促进团队对目标、角色和职责的关注方面，针对性促进可能比一般性方法更有效。
