Quality in Primary Care Open Access

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Key activities used by community based primary care practices to improve the quality of diabetes care in response to practice facilitation

Polly Hitchcock Noel

Background recent systematic review suggests that practice facilitation (PF) is a robust intervention for implementing evidence-based preventive care guidelines in primary care, but the ability of PF to improve chronic illness care remains unclear. Aims To examine the specific activities and chronic care model (CCM) components that primary care practices implemented and sustained in response to a 12-month PF intervention. Methods The ABC trial tested the effectiveness of PF to improve care for diabetes in 40 small community based primary care practices that were randomised to ‘initial’ or ‘delayed’ intervention arms. A trained facilitator met with each practice over 12 months. Facilitators used interactive consensus building to help practices implement one or more of quality improvement activities based on the CCM. Facilitators prospectively recorded implementation activities reported by practice teams during monthly meetings and confirmed which of these were sustained at the end of the intervention. Results Thirty seven practices implemented and sustained a total of 43 unique activities (range 1–15, average 6.5 [SD= 2.9] ). The number (%) of practices that implemented one or more key activities in each CCM component varied: patient self-management support: 37 (100%); clinical information systems: 24 (64.9%); delivery system design: 14 (37.8%); decision support: 13 (35.1%); community linkages: 2 (5.4%); healthcare system support: 2 (2.7%). The majority of practices (59%) only implemented activities from one or two CCM components. The number of sustained activities was associated with the number of PF visits, but not with practice characteristics. Conclusion In spite of the PF intervention, it was difficult for these small practices to implement comprehensive CCM changes. Although practices implemented and sustained a remarkable number and variety of key activities, the majority of these focused on patient self-management support, as opposed to other components of the CCM, such as clinical information systems, decision support, delivery system redesign, and community linkages