Implementing practice facilitation in research: how facilitators spend their time guiding practices to improve blood pressure control.
Implementing practice facilitation in research: how facilitators spend their time guiding practices to improve blood pressure control.
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DOI：
10.1186/s43058-023-00470-y
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发表时间：
2023-07-31
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实践促进者 (PF) 通过旨在提高患者治疗效果和运营效率的质量改进 (QI) 举措来指导实践。实践促进是一种动态干预，根据设计，是根据实践的独特需求和环境量身定制的。很少有研究探讨 PF 花在 QI 活动实践上的时间。这份简短的报告扩展了之前发表的工作，该工作详细介绍了为期 12 个月的练习促进干预措施，作为东南部改善血压控制合作 (SEC) 试验的一部分，该试验的重点是改善美国东南部农村地区居民的高血压控制。本报告分析了 PF 指导 32 个初级保健实践实施 QI 活动以支持改善高血压患者预后所花费的时间的数据。 SEC 试验在所有实践地点雇用了四名经过认证的 PF，他们记录了所花费的时间：(1) 开车支持实践； (2) 与工作人员和临床医生一起进行现场工作； (3) 与执业成员进行远程沟通（电话、电子邮件或视频会议）。我们使用描述性统计分析数据，以帮助了解用于个人和聚合任务的时间。此外，我们还探讨了实践特征与 PF 花费时间之间的相关性。总体而言，PF 完成了 416 次训练访问，每次访问平均花费 130 (SD 65) 分钟开车往返训练。每次访问现场花费的平均练习时间为 87 (SD 37) 分钟，而平均花费在个人远程通信上的时间为 17 (SD 12) 分钟。在12个月的干预期间，进行了1131次远程交流与实践。 PF 大部分时间都花在临床工作人员（n = 886 例）或单独的实践经理（n = 670 例）上，而单独与初级保健提供者进行相对较少的现场访问（n = 15）。在 19 项实践中，没有任何沟通是单独与提供者进行的。在 PF 活动上花费的时间与医疗补助和未参保患者的比例、工作人员与提供者的比例或联邦合格健康中心 (FQHC) 状态之间没有发现显着相关性。为农村高血压患者提供服务的 PF 投入大量时间在驾驶上，这凸显了优化现场时间与远程沟通时间之间平衡的重要性。大部分时间都花在临床工作人员身上，而不是初级保健提供者身上。这些发现可能对设计、测试和实施高效便利服务的研究人员和商业领袖有用。 NIH ClinicalTrials.gov NCT02866669。注册于 2016 年 8 月 15 日。NHLBI 奖项编号：PCS-1UH3HL130691。
Practice facilitators (PFs) coach practices through quality improvement (QI) initiatives aimed at enhancing patient outcomes and operational efficiencies. Practice facilitation is a dynamic intervention that, by design, is tailored to practices’ unique needs and contexts. Little research has explored the amount of time PFs spend with practices on QI activities. This short report expands on previously published work that detailed a 12-month practice facilitation intervention as part of the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial, which focused on improving hypertension control among people living in rural settings in the southeastern USA. This report analyzes data on the time PFs spent to guide 32 primary care practices in implementing QI activities to support enhanced outcomes in patients with high blood pressure. The SEC trial employed four certified PFs across all practice sites, who documented time spent: (1) driving to support practices; (2) working on-site with staff and clinicians; and (3) communicating remotely (phone, email, or video conference) with practice members. We analyzed the data using descriptive statistics to help understand time devoted to individual and aggregated tasks. Additionally, we explored correlations between practice characteristics and time spent with PFs. In aggregate, the PFs completed 416 visits to practices and spent an average of 130 (SD 65) min per visit driving to and from practices. The average time spent on-site per visit with practices was 87 (SD 37) min, while an average of 17 (SD 12) min was spent on individual remote communications. During the 12-month intervention, 1131 remote communications were conducted with practices. PFs spent most of their time with clinical staff members (n = 886 instances) or with practice managers alone (n = 670 instances) while relatively few on-site visits were conducted with primary care providers alone (n = 15). In 19 practices, no communications were solely with providers. No significant correlations were found between time spent on PF activities and a practices’ percent of Medicaid and uninsured patients, staff-provider ratio, or federally qualified health center (FQHC) status. PFs working with practices serving rural patients with hypertension devote substantial time to driving, highlighting the importance of optimizing a balance between time spent on-site vs. communicating remotely. Most time spent was with clinical staff, not primary care providers. These findings may be useful to researchers and business leaders who design, test, and implement efficient facilitation services. NIH ClinicalTrials.gov NCT02866669. Registered on 15 August 2016. NHLBI AWARD number: PCS-1UH3HL130691.