11th Annual Dissemination and Implementation Conference
Washington DC | December 3-5, 2018
Implementing improved cardiovascular preventive care in primary care practices
Authors: Deb Cohen, Shannon Sweeney, Will Miller, Jennifer Hall, Tanisha Tate Woodson, Bijal Balasubramanian, Miguel Marino, Rachel Springer, Ben Crabtree, Leif Solberg
Findings: Of the 1,047 practices that submitted A, BP, S data at ≥4 timepoints, cluster analyses revealed a large proportion of practices (83% for A, 53% for BP, 54% for S) did not change significantly or performance decreased over time. For BP, 22% of practices demonstrated steady, modest improvement (change over time <10%); only 3% showed large and rapid improvement. 8% and 20% of practices showed large, dramatic improvements (>30% change in performance over two years) in A and S measures respectively; notably, none demonstrated steady improvement over time. QCA findings showed that documentation change was one approach for improving A and S measures, but not for improving BP, possibly explaining the large, dramatic A and S changes observed. Improving BP involved extensive practice change, including steps to assure accuracy of readings and to re-engage patients with high readings, which may explain the steady, small increases observed in BP.
Measuring the Dose of External Practice Facilitation
Authors: Bijal Balasubramanian, David Ezekiel-Herrera, Shannon Sweeney, Miguel Marino, Rikki Ward, Leah Gordon, Ben Crabtree, Leif Solberg, Will Miller, Deb Cohen
Findings: We observed substantial variation in the time from the first to last facilitation visit across practices (ranging from an average of 1.5 to 21 months), in number of in-person facilitation visits (ranging on average from 4 to 28), and in total amount of time practices received in-person facilitation (ranging on average from 7 to 50 hours). Qualitative data suggested these variations were attributable to Cooperative conceptual framework and design, practice engagement and motivation, information technology and data challenges, practice disruptions (e.g., staff changes), and competing demands. Guided by qualitative findings, we further characterized facilitation dose as: delays in starting facilitationvisits, “lulls” between visits, and stops to facilitation prior to the intervention end date. We developed a theoretical framework showing components of facilitation dose, the factors that explain variation in dose, and how these factors might relate to facilitation effectiveness.