Does coaching matter? Examining the impact of specific practice facilitation strategies on implementation of quality improvement interventions in the Healthy Hearts in the Heartland study

Abstract

Background: Practice facilitation is a multicomponent implementation strategy used to improve the capacity for practices to address care quality and implementation gaps. We sought to assess whether practice facilitators use of coaching strategies aimed at improving self-sufficiency were associated with improved implementation of quality improvement (QI) interventions in the Healthy Hearts in the Heartland Study.

Methods: We mapped 27 practice facilitation activities to a framework that classifies practice facilitation strategies by the degree to which the practice develops its own process expertise (Doing Tasks, Project Management, Consulting, Teaching, and Coaching) and then used regression tree analysis to group practices by facilitation strategies experienced. Kruskal-Wallis tests were used to assess whether practice groups identified by regression tree analysis were associated with successful implementation of QI interventions and practice and study context variables.

Results: There was no association between number of strategies performed by practice facilitators and number of QI interventions implemented. Regression tree analysis identified 4 distinct practice groups based on the number of Project Management and Coaching strategies performed. The median number of interventions increased across the groups. Practices receiving > 4 project management and > 6 coaching activities implemented a median of 17 of 35 interventions. Groups did not differ significantly by practice size, association with a healthcare network, or practice type. Statistically significant differences in practice location, number and duration of facilitator visits, and early study termination emerged among the groups, compared to the overall practice population.

Conclusions: Practices that engage in more coaching-based strategies with practice facilitators are more likely to implement more QI interventions, and practice receptivity to these strategies was not dependent on basic practice demographics.

Keywords: Cardiovascular care; Practice facilitation; Primary care; Quality improvement; Strategy framework.

Fig. 1

The Practice facilitation strategy spectrum framework as described by Baker et al. [30]

Fig. 2

a H3 standard facilitation actvities mapped to the spectrum of practice facilitation strategies. b Number and frequency of strategies across all practices experienced by all 226 practices in the H3 study

Fig. 3

Frequency of practice facilitation activities (grouped by practice facilitation strategy) experienced by practices in H3 and completed interventions by practices in H3

Fig. 4

Regression tree analysis for the spectrum of practice facilitation strategies experienced by the 226 practices in the H3 study. Spectrum pictures in subgroup boxes represent the distribution of the activities received by practices in that subgroup, grouped by strategy type

Fig. 5

Box plot of the distribution of interventions completed by practices participating in the H3 study as assessed by regression tree segmentation