Identifying Contextual Factors and Strategies for Practice Facilitation in Primary Care Quality Improvement Using an Informatics-Driven Model: Framework Development and Mixed Methods Case Study.
Identifying Contextual Factors and Strategies for Practice Facilitation in Primary Care Quality Improvement Using an Informatics-Driven Model: Framework Development and Mixed Methods Case Study.
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过去十年，将质量改进纳入医疗保健的机会和努力不断增加。实践促进是一项行之有效的策略，支持初级保健实践的重新设计和改进，重点是建设持续改进的组织能力。实践领导、工作人员和实践促进者在支持初级保健质量改进方面都发挥着重要作用。然而，人们对他们对影响质量改进计划的背景、推动因素、障碍和策略的看法知之甚少。本研究旨在开发一个框架，以评估影响实践便利、临床测量绩效和质量改进干预措施实施的背景因素、挑战和策略。我们还通过实际案例研究说明了该框架的应用。我们通过举办参与式利益相关者研讨会并结合他们的观点来确定质量改进和实践促进的推动因素和障碍，从而开发了 TITO（任务、个人、技术和组织）框架。我们使用混合方法进行了一项案例研究，以展示该框架的使用，并描述参与“心脏地带健康心脏”研究的初级保健实践的实践便利性和影响质量改进的因素。所提出的框架用于根据框架领域组织和分析不同利益相关者的观点和关键因素。案例研究表明，实践领导者、员工和实践促进者都会影响质量改进计划的成功。然而，这些参与者面临着不同的挑战并采用了不同的策略。该框架表明，障碍源于患者健康的社会决定因素、缺乏人员和时间以及不系统的促进资源，而推动因素包括实践文化、员工支持、有效实践促进策略的实施、变革的实践能力以及共享来自类似、正在进行的项目的补充资源。我们的框架提供了一个有用且可概括的结构，以指导和支持对未来实践促进项目、质量改进举措和医疗保健干预实施研究的评估。实践领导者、员工和实践促进者都看到了质量改进计划和实践促进的价值。实践促进者是帮助质量改进计划的关键联络人；他们帮助所有利益相关者努力实现共同目标并利用量身定制的战略。利用竞争性但互补性计划的资源作为额外支持可以加速质量改进目标的有效实现。实践便利化支持的质量改进计划可能是协助初级保健实践通过集中和有针对性的努力提高护理质量的机会。该案例研究展示了我们的框架如何支持更好地理解促进实践的背景因素，这可以为初级保健实践提供准备充分且更成功的质量改进计划。我们的 TITO 框架将实施科学和信息学思维相结合，可以促进这两个领域的跨学科研究。
The past decade has seen increasing opportunities and efforts to integrate quality improvement into health care. Practice facilitation is a proven strategy to support redesign and improvement in primary care practices that focuses on building organizational capacity for continuous improvement. Practice leadership, staff, and practice facilitators all play important roles in supporting quality improvement in primary care. However, little is known about their perspectives on the context, enablers, barriers, and strategies that impact quality improvement initiatives. This study aimed to develop a framework to enable assessment of contextual factors, challenges, and strategies that impact practice facilitation, clinical measure performance, and the implementation of quality improvement interventions. We also illustrated the application of the framework using a real-world case study. We developed the TITO (task, individual, technology, and organization) framework by conducting participatory stakeholder workshops and incorporating their perspectives to identify enablers and barriers to quality improvement and practice facilitation. We conducted a case study using a mixed methods approach to demonstrate the use of the framework and describe practice facilitation and factors that impact quality improvement in a primary care practice that participated in the Healthy Hearts in the Heartland study. The proposed framework was used to organize and analyze different stakeholders’ perspectives and key factors based on framework domains. The case study showed that practice leaders, staff, and practice facilitators all influenced the success of the quality improvement program. However, these participants faced different challenges and used different strategies. The framework showed that barriers stemmed from patients’ social determinants of health, a lack of staff and time, and unsystematic facilitation resources, while enablers included practice culture, staff buy-in, implementation of effective practice facilitation strategies, practice capacity for change, and shared complementary resources from similar, ongoing programs. Our framework provided a useful and generalizable structure to guide and support assessment of future practice facilitation projects, quality improvement initiatives, and health care intervention implementation studies. The practice leader, staff, and practice facilitator all saw value in the quality improvement program and practice facilitation. Practice facilitators are key liaisons to help the quality improvement program; they help all stakeholders work toward a shared target and leverage tailored strategies. Taking advantage of resources from competing, yet complementary, programs as additional support may accelerate the effective achievement of quality improvement goals. Practice facilitation–supported quality improvement programs may be opportunities to assist primary care practices in achieving improved quality of care through focused and targeted efforts. The case study demonstrated how our framework can support a better understanding of contextual factors for practice facilitation, which could enable well-prepared and more successful quality improvement programs for primary care practices. Combining implementation science and informatics thinking, our TITO framework may facilitate interdisciplinary research in both fields.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
6
作者：
Binder CR;Absenger-Helmli I;Schilling T
通讯作者：
Schilling T
影响因子：
1.3
作者：
McHugh, Megan;Brown, Tiffany;Persell, Stephen D.
通讯作者：
Persell, Stephen D.
影响因子：
1.8
作者：
Kendall, J
通讯作者：
Kendall, J
影响因子：
4.4
作者：
McHugh, Megan;Brown, Tiffany;Persell, Stephen D.
通讯作者：
Persell, Stephen D.