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03.01.2022 | Original Research: Qualitative Research

How Type of Practice Ownership Affects Participation with Quality Improvement External Facilitation: Findings from EvidenceNOW

verfasst von: Cynthia K. Perry, PhD, FNP-BC, FAHA, Stephan Lindner, PhD, Jennifer Hall, MPH, Leif I. Solberg, MD, Andrea Baron, MPH, Deborah J. Cohen, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2022

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Abstract

Background

Facilitation is an implementation strategy that can help primary care practices improve healthcare quality and build quality improvement (QI) capacity when delivered in a flexible manner by trained professionals. Practice ownership is associated with use of QI. However, little is known about how practices of different ownership participate in external facilitation, and this could inform future initiatives.

Objective

Using data from EvidenceNOW, we examined how practice ownership influences participation in external facilitation.

Study Design

We used an iterative mixed-methods design.

Participants, Approach, and Measures

We collected data from practices on practice characteristics (e.g., location, size, payer mix) and ownership type via surveys and from facilitators on the number of hours, encounters, and months each practice had with a facilitator via facilitation logs. Using multivariable linear regression, we examined the association between facilitation and ownership (n = 1117 practices). We conducted semi-structured interviews with EvidenceNOW leadership (n = 12) and facilitators (n = 51) and observed facilitators in a subset of practices (n = 64); we analyzed this qualitative data for patterns of facilitation.

Key Results

In the fully adjusted model, differences by ownership were non-significant; FQHCs, however, had significantly less participation in facilitation than clinician-owned practices across two measures (unadjusted difference: − 2.83, p < 0.01 for number of encounters, and − 2.04, p < 0.01 for number of months with encounters). Qualitative data showed that Health System and FQHC ownership influenced types of practices enrolled in EvidenceNOW, and suggested that in these practices lower autonomy and greater complexity compared to clinician-owned ownership influenced facilitation participation patterns.

Conclusions

Practice ownership shaped how but not how much practices participated in external facilitation. This finding highlights the importance of tailoring facilitation approaches based on ownership-related characteristics in future QI initiatives.

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Titel: How Type of Practice Ownership Affects Participation with Quality Improvement External Facilitation: Findings from EvidenceNOW
verfasst von: Cynthia K. Perry, PhD, FNP-BC, FAHA
Stephan Lindner, PhD
Jennifer Hall, MPH
Leif I. Solberg, MD
Andrea Baron, MPH
Deborah J. Cohen, PhD
Publikationsdatum: 03.01.2022
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine / Ausgabe 4/2022
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-021-07204-7

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Abstract

Background

Objective

Study Design

Participants, Approach, and Measures

Key Results

Conclusions

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