Institute for Public Health and Medicine, Center for Healthcare Studies and Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois.
Ann Fam Med. 2018 Apr;16(Suppl 1):S65-S71. doi: 10.1370/afm.2197.
Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged.
We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data.
We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices.
The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects.
实践促进是帮助实践实施质量改进的一种很有前途的方法。我们的目的是描述实践促进者和实践领导者对实施实践促进者支持的质量改进计划的看法，并描述他们的观点一致和分歧的地方。
我们对参与了一个包含 35 项旨在改善心脏健康的 ABCS（高危人群使用阿司匹林、血压控制、胆固醇管理和戒烟）的改进策略的计划的实践领导者和实践促进者进行了访谈。快速定性分析用于收集、组织和分析数据。
我们采访了 33 名符合条件的实践领导者中的 17 名，以及被分配到这些实践的 10 名实践促进者。实践领导者和实践促进者都报告说，该计划有能力为实践带来所需的高质量资源，这是有价值的。实践领导者赞赏能够为促进活动安排时间表，并在 35 项干预措施中进行选择。然而，根据实践促进者的说法，依赖实践领导者来确定干预的节奏导致了计划强度低于预期。实践领导者更喜欢有针对性的帮助，特别是电子健康记录记录指导和与州戒烟计划的联系。实践促进者报告说，最容易的干预措施是那些不改变护理实践的干预措施。
实践领导者和实践促进者的双重观点提供了一个更全面的方案实施促进者和障碍的图景。通过简单的、有针对性的实践促进者支持的努力，而不是更大、更全面的质量改进项目，可能有更多的机会来帮助小型实践。
