Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program
Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program
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DOI：
10.1370/afm.2197
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发表时间：
2018-04-01
影响因子：
4.4
通讯作者：
Persell, Stephen D.
中科院分区：
文献类型：
--
作者：
McHugh, Megan;Brown, Tiffany;Persell, Stephen D.
实践促进是帮助实践实施质量改进的一种有前途的方法。我们的目的是描述实践促进者和实践领导者对实践促进者支持的质量改进计划的实施的观点，并描述他们的观点一致和分歧的地方。方法我们对参与计划的实践领导者和实践促进者进行了访谈，该计划包括35项针对心脏健康ABCS的改进策略（阿司匹林在高危人群中的使用，血压控制，胆固醇管理和戒烟）。快速定性分析被用来收集，组织和分析data.RESULTS，我们采访了17的33个合格的实践领导者，和10个实践促进者分配到这些做法。实践领导者和实践促进者都报告了该计划为实践带来所需的高质量资源的能力的价值。实践领导者赞赏能够制定促进时间表并在35项干预措施中进行选择。然而，根据实践促进者的说法，依靠实践领导者来设定干预的速度导致了比预期更低的计划强度。实践领导者更喜欢有针对性的援助，特别是电子健康记录文件指导和与州戒烟计划的联系。实践促进者报告说，最简单的干预措施是那些不改变护理practices.CONCLUSIONS实践领导者和实践促进者的双重视角提供了一个更全面的画面，使能和障碍，以计划的实施。通过简单、有针对性的实践促进者支持的努力，而不是更大、全面的质量改进项目，可能有更多的机会来帮助小型实践。
PURPOSE 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.METHODS 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.RESULTS 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.CONCLUSIONS 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.