Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

doi:10.1186/s12913-020-05552-4

. 2020 Jul 28;20(1):695.

doi: 10.1186/s12913-020-05552-4.

Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

Jacqueline R Halladay^{1

2}, Bryan J Weiner³, Jung In Kim^{4

5}, Darren A DeWalt⁶, Stephanie Pierson⁷, Jason Fine⁸, Ann Lefebvre⁹, Monique Mackey¹⁰, Dawn Bergmire⁷, Crystal Cené⁶, Kamal Henderson¹¹, Samuel Cykert^{7

6}

Affiliations

¹ Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB #7595, Chapel Hill, NC, 27599-7595, USA. Jacqueline_halladay@med.unc.edu.
² Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB #7590, Chapel Hill, NC, 27599-7590, USA. Jacqueline_halladay@med.unc.edu.
³ Department of Global Health, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.
⁴ Department of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, State College, PA, USA.
⁵ Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, State College, PA, USA.
⁶ Division of General Medicine and Clinical Epidemiology, Department of Medicine, The University of North Carolina at Chapel Hill, 5034 Old Clinic Bldg, CB #7110, Chapel Hill, NC, 27599-7110, USA.
⁷ Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB #7590, Chapel Hill, NC, 27599-7590, USA.
⁸ Department of Biostatistics, Gilling's School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599-7420, USA.
⁹ Department of Family Medicine, South Carolina Area Health Education Center, Medical University of South Carolina, 5 Charleston Center, Suite 263, Charleston, SC, 29425, USA.
¹⁰ Area L AHEC, 1631 S Wesleyan Blvd, Rocky Mount, NC, 27804, USA.
¹¹ Division of Cardiology, Department of Medicine, The University of North Carolina at Chapel Hill, 6th Floor, Burnett-Womack Bldg, 160 Dental Circle, CB #7075, Chapel Hill, NC, 27599-7075, USA.

PMID: 32723386
PMCID: PMC7388469
DOI: 10.1186/s12913-020-05552-4

Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

Jacqueline R Halladay et al. BMC Health Serv Res. 2020.

. 2020 Jul 28;20(1):695.

doi: 10.1186/s12913-020-05552-4.

Authors

Affiliations

¹ Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB #7595, Chapel Hill, NC, 27599-7595, USA. Jacqueline_halladay@med.unc.edu.
² Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB #7590, Chapel Hill, NC, 27599-7590, USA. Jacqueline_halladay@med.unc.edu.
³ Department of Global Health, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.
⁴ Department of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, State College, PA, USA.
⁵ Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, State College, PA, USA.
⁶ Division of General Medicine and Clinical Epidemiology, Department of Medicine, The University of North Carolina at Chapel Hill, 5034 Old Clinic Bldg, CB #7110, Chapel Hill, NC, 27599-7110, USA.
⁷ Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB #7590, Chapel Hill, NC, 27599-7590, USA.
⁸ Department of Biostatistics, Gilling's School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599-7420, USA.
⁹ Department of Family Medicine, South Carolina Area Health Education Center, Medical University of South Carolina, 5 Charleston Center, Suite 263, Charleston, SC, 29425, USA.
¹⁰ Area L AHEC, 1631 S Wesleyan Blvd, Rocky Mount, NC, 27804, USA.
¹¹ Division of Cardiology, Department of Medicine, The University of North Carolina at Chapel Hill, 6th Floor, Burnett-Womack Bldg, 160 Dental Circle, CB #7075, Chapel Hill, NC, 27599-7075, USA.

PMID: 32723386
PMCID: PMC7388469
DOI: 10.1186/s12913-020-05552-4

Abstract

Background: Practice facilitation is a promising strategy to enhance care processes and outcomes in primary care settings. It requires that practices and their facilitators engage as teams to drive improvement. In this analysis, we explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month practice facilitation intervention focused on implementing cardiovascular prevention activities in practice. Understanding factors associated with greater engagement with facilitators in practice-based quality improvement can assist practice facilitation programs with planning and resource allocation.

Methods: One hundred thirty-six ambulatory care small to medium sized primary care practices that participated in the EvidenceNow initiative's NC Cooperative, named Heart Health Now (HHN), fit the eligibility criteria for this analysis. We explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month intervention using a retrospective cohort design that included baseline survey data, monthly practice activity implementation data and information about facilitator's experience. Generalized linear mixed-effects models (GLMMs) identified variables associated with greater odds of team engagement using an ordinal scale for level of team engagement.

Results: Among our practice cohort, over half were clinician-owned and 27% were Federally Qualified Health Centers. The mean number of clinicians was 4.9 (SD 4.2) and approximately 40% of practices were in Medically Underserved Areas (MUA). GLMMs identified a best fit model. The Model presented as odd ratios and 95% confidence intervals suggests greater odds ratios of higher team engagement with greater practice QI leadership 17.31 (5.24-57.19), [0.00], and practice location in a MUA 7.25 (1.8-29.20), [0.005]. No facilitator characteristics were independently associated with greater engagement.

Conclusions: Our analysis provides information for practice facilitation stakeholders to consider when considering which practices may be more amendable to embracing facilitation services.

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Conflict of interest statement

The authors declare no competing interest. To the best of our knowledge, no competing interests, financial or other, exist.

Figures

**Fig. 1**
Conceptual Model: HHN Primary Care Practice Engagement with Practice Facilitators and Team Members

**Fig. 2**
Selection of Analytical Practice Cohort

See this image and copyright information in PMC

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References

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1. Parchman ML, Noel PH, Culler SD, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci. 2013;8:93. doi: 10.1186/1748-5908-8-93. - DOI - PMC - PubMed
1. Bryce FP, Neville RG, Crombie IK, Clark RA, McKenzie P. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ (Clinical research ed) 1995;310(6983):838–842. doi: 10.1136/bmj.310.6983.838. - DOI - PMC - PubMed
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[1] Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–944. doi: 10.1161/CIR.0b013e31820a55f5. - DOI - PubMed

[2] Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–944. doi: 10.1161/CIR.0b013e31820a55f5. - DOI - PubMed

[3] Frieden TR, Berwick DM. The “million hearts” initiative--preventing heart attacks and strokes. N Engl J Med. 2011;365(13):e27. doi: 10.1056/NEJMp1110421. - DOI - PubMed

[4] Frieden TR, Berwick DM. The “million hearts” initiative--preventing heart attacks and strokes. N Engl J Med. 2011;365(13):e27. doi: 10.1056/NEJMp1110421. - DOI - PubMed

[5] Parchman ML, Noel PH, Culler SD, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci. 2013;8:93. doi: 10.1186/1748-5908-8-93. - DOI - PMC - PubMed

[6] Parchman ML, Noel PH, Culler SD, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci. 2013;8:93. doi: 10.1186/1748-5908-8-93. - DOI - PMC - PubMed

[7] Bryce FP, Neville RG, Crombie IK, Clark RA, McKenzie P. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ (Clinical research ed) 1995;310(6983):838–842. doi: 10.1136/bmj.310.6983.838. - DOI - PMC - PubMed

[8] Bryce FP, Neville RG, Crombie IK, Clark RA, McKenzie P. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ (Clinical research ed) 1995;310(6983):838–842. doi: 10.1136/bmj.310.6983.838. - DOI - PMC - PubMed

[9] Hogg W, Baskerville N, Lemelin J. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis. BMC Health Serv Res. 2005;5(1):20. doi: 10.1186/1472-6963-5-20. - DOI - PMC - PubMed

[10] Hogg W, Baskerville N, Lemelin J. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis. BMC Health Serv Res. 2005;5(1):20. doi: 10.1186/1472-6963-5-20. - DOI - PMC - PubMed

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Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

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Practice level factors associated with enhanced engagement with practice facilitators; findings from the heart health now study

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

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