A Taxonomy for External Support for Practice Transformation

doi:10.3122/jabfm.2021.01.200225

. 2021 Jan-Feb;34(1):32-39.

doi: 10.3122/jabfm.2021.01.200225.

A Taxonomy for External Support for Practice Transformation

Leif I Solberg¹, Anton Kuzel², Michael L Parchman², Donna R Shelley², W Perry Dickinson², Theresa L Walunas², Ann M Nguyen², Lyle J Fagnan², Samuel Cykert², Deborah J Cohen², Bijal A Balasubramanaian², Douglas Fernald², Leah Gordon², Abel Kho², Alex Krist², William Miller², Carolyn Berry², Daniel Duffy², Zsolt Nagykaldi²

Affiliations

¹ From Health Partners Institute, Minneapolis, MN (LIS); Virginia Commonwealth University, Richmond, VA (AKu, AKr); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MLP); School of Global Public Health, New York University (NYU), New York, NY (DRS); University of Colorado, Aurora, CO (WPD, DF); Feinberg School of Medicine, Northwestern University, Chicago, IL (TLW, AKh); NYU Langone Health, New York NY, (AMN, CB); Oregon Health Sciences University, Portland, OR (LRF, DJC, LG); University of North Carolina at Chapel Hill, Chapel Hill, NC (SC); School of Public Health, UTHealth, Dallas, TX (BAB); Lehigh Valley Health Center, Easton, PA (WM); University of Oklahoma, Oklahoma City, OK (DD, ZN). leif.i.solberg@healthpartners.com.
² From Health Partners Institute, Minneapolis, MN (LIS); Virginia Commonwealth University, Richmond, VA (AKu, AKr); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MLP); School of Global Public Health, New York University (NYU), New York, NY (DRS); University of Colorado, Aurora, CO (WPD, DF); Feinberg School of Medicine, Northwestern University, Chicago, IL (TLW, AKh); NYU Langone Health, New York NY, (AMN, CB); Oregon Health Sciences University, Portland, OR (LRF, DJC, LG); University of North Carolina at Chapel Hill, Chapel Hill, NC (SC); School of Public Health, UTHealth, Dallas, TX (BAB); Lehigh Valley Health Center, Easton, PA (WM); University of Oklahoma, Oklahoma City, OK (DD, ZN).

PMID: 33452080
PMCID: PMC9190131
DOI: 10.3122/jabfm.2021.01.200225

A Taxonomy for External Support for Practice Transformation

Leif I Solberg et al. J Am Board Fam Med. 2021 Jan-Feb.

. 2021 Jan-Feb;34(1):32-39.

doi: 10.3122/jabfm.2021.01.200225.

Authors

Affiliations

¹ From Health Partners Institute, Minneapolis, MN (LIS); Virginia Commonwealth University, Richmond, VA (AKu, AKr); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MLP); School of Global Public Health, New York University (NYU), New York, NY (DRS); University of Colorado, Aurora, CO (WPD, DF); Feinberg School of Medicine, Northwestern University, Chicago, IL (TLW, AKh); NYU Langone Health, New York NY, (AMN, CB); Oregon Health Sciences University, Portland, OR (LRF, DJC, LG); University of North Carolina at Chapel Hill, Chapel Hill, NC (SC); School of Public Health, UTHealth, Dallas, TX (BAB); Lehigh Valley Health Center, Easton, PA (WM); University of Oklahoma, Oklahoma City, OK (DD, ZN). leif.i.solberg@healthpartners.com.
² From Health Partners Institute, Minneapolis, MN (LIS); Virginia Commonwealth University, Richmond, VA (AKu, AKr); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MLP); School of Global Public Health, New York University (NYU), New York, NY (DRS); University of Colorado, Aurora, CO (WPD, DF); Feinberg School of Medicine, Northwestern University, Chicago, IL (TLW, AKh); NYU Langone Health, New York NY, (AMN, CB); Oregon Health Sciences University, Portland, OR (LRF, DJC, LG); University of North Carolina at Chapel Hill, Chapel Hill, NC (SC); School of Public Health, UTHealth, Dallas, TX (BAB); Lehigh Valley Health Center, Easton, PA (WM); University of Oklahoma, Oklahoma City, OK (DD, ZN).

PMID: 33452080
PMCID: PMC9190131
DOI: 10.3122/jabfm.2021.01.200225

Abstract

Background: There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. Our goal was to develop such a taxonomy that could be used by both external groups or researchers and health care leaders.

Methods: The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention. Combining literature reviews with our practical experiences in this initiative and past work, we aimed to define these domains and recommend measures for them.

Results: The taxonomy includes 1 domain to specify the conceptual model(s) on which an intervention is built and another to specify the types of support strategies used. Another 5 domains provide specifics about the dose/mode of that support, the types of change process and care process changes that are encouraged, and the degree to which the strategies are prescriptive and standardized. A model was created to illustrate how the domains fit together and how they would respond to practice needs and reactions.

Conclusions: This taxonomy and its use in more consistently documenting and characterizing external support interventions should facilitate communication and synergies between 3 areas (quality improvement, practice change research, and implementation science) that have historically tended to work independently. The taxonomy was designed to be as useful for practices or health systems managing change as it is for research.

Keywords: Change Management; Delivery of Health Care; Diffusion of Innovation; Implementation Science; Organizational Innovation; Primary Health Care; Quality Improvement.

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Conflict of interest statement

Conflict of interest: None.

Figures

**Figure 1.**
Domain and Agent Relationships.

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References

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[1] Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med 1989;320(1):53–56. - PubMed

[2] Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med 1989;320(1):53–56. - PubMed

[3] Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med 2012;43:337–50. - PMC - PubMed

[4] Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med 2012;43:337–50. - PMC - PubMed

[5] Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med 2012; 10:63–74. - PMC - PubMed

[6] Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med 2012; 10:63–74. - PMC - PubMed

[7] Coly A, Parry G. Evaluating complex health interventions: a guide to rigorous research designs. 2017. Available from: https://www.academyhealth.org/evaluationguide. Accessed November 15, 2018.

[8] Coly A, Parry G. Evaluating complex health interventions: a guide to rigorous research designs. 2017. Available from: https://www.academyhealth.org/evaluationguide. Accessed November 15, 2018.

[9] Nilsen P Making sense of implementation theories, models and frameworks. Implement Sci 2015;10:53. - PMC - PubMed

[10] Nilsen P Making sense of implementation theories, models and frameworks. Implement Sci 2015;10:53. - PMC - PubMed

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A Taxonomy for External Support for Practice Transformation

Affiliations

A Taxonomy for External Support for Practice Transformation

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Conflict of interest statement

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