Rutgers University, New Brunswick, NJ, USA.
NYU Langone Health, New York, NY, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720984411. doi: 10.1177/2150132720984411.
HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation on the adoption of cardiovascular disease guidelines in small primary care practices. The objective of this study was to identify was to identify attributes of small practices that signaled they would perform well in a practice facilitation intervention implementation.
A mixed methods multiple-case study design was used. Six small practices were selected representing 3 variations in meeting the practice-level benchmark of >70% of hypertensive patients having controlled blood pressure. Inductive and deductive approaches were used to identify themes and assign case ratings. Cross-case rating comparison was used to identify attributes of high performing practices.
Our first key finding is that the high-performing and improved practices in our study looked and acted similarly during the intervention implementation. The second key finding is that 3 attributes emerged in our analysis of determinants of high performance in small practices: (1) advanced use of the EHR; (2) dedicated resources and commitment to quality improvement; and (3) actively engaged lead clinician and office manager.
These attributes may be important determinants of high performance, indicating not only a small practice's capability to engage in an intervention but possibly also its readiness to change. We recommend developing tools to assess readiness to change, specifically for small primary care practices, which may help external agents, like practice facilitators, better translate intervention implementations to context.
HealthyHearts NYC 是一项阶梯式随机对照试验，旨在测试实践促进对小型初级保健实践中采用心血管疾病指南的有效性。本研究的目的是确定哪些属性的小型实践表明它们将在实践促进干预实施中表现良好。
采用混合方法多案例研究设计。选择了六家小型实践，代表了在满足实践水平基准（>70%的高血压患者血压得到控制）方面的三种变化。采用归纳和演绎方法来确定主题并分配案例评分。跨案例评分比较用于确定高绩效实践的属性。
我们的第一个主要发现是，我们研究中表现出色且有所改善的实践在干预实施过程中表现相似。第二个主要发现是，在我们对小型实践中高绩效的决定因素的分析中出现了三个属性：（1）电子病历的高级使用；（2）对质量改进的专用资源和承诺；以及（3）积极参与的主治临床医生和办公室经理。
这些属性可能是高绩效的重要决定因素，不仅表明小型实践参与干预的能力，还可能表明其变革的准备情况。我们建议开发工具来评估变革的准备情况，特别是针对小型初级保健实践，这可能有助于外部机构（如实践促进者）更好地将干预措施转化为背景。
