The Northwest Coalition for Primary Care Practice Support
- Conditions
- Cardiovascular DiseaseEssential HypertensionNicotine DependenceHyperlipidemia
- Interventions
- Other: CoachingOther: Educational OutreachOther: Site Visits
- Registration Number
- NCT02839382
- Lead Sponsor
- Kaiser Permanente
- Brief Summary
The purpose of this project is to build capacity for quality improvement (QI) in small primary care practices across Washington, Oregon and Idaho by improving risk factors for heart attacks such as blood pressure, cholesterol and smoking. The Northwest Coalition for Primary Care Practice Support will assist practices by providing them with a QI coach, creating group learning opportunities, and conducting educational outreach activities. An innovative study design will be used to determine what levels and types of support are most helpful and effective.
- Detailed Description
The Northwest Coalition for Primary Care Practice Support will provide a comprehensive and robust external practice support infrastructure for small and medium primary care practices across Washington (WA), Oregon (OR) and Idaho (ID) to build their internal quality improvement (QI) capacity and improve performance on the heart health indicators of aspirin use, blood pressure and cholesterol control and smoking cessation (ABCS indicators) by disseminating and supporting the implementation of relevant Patient Centered Outcomes Research findings. This coalition of partners has a remarkable track record of collaboration and improving primary care practice: the MacColl Center for Health Care Innovation and the Center for Community Health Evaluation at Group Health Research Institute; Qualis Health, the Health IT Regional Extension Center (REC) and designated Quality Improvement Organization (QIO) for WA and ID; and the Oregon Rural Practice-based Research Network (ORPRN), along with state-level partners who are membership organizations for clinicians in small practice settings. Recruitment will leverage existing small practice relationships between Qualis Health as the health information technology (IT) REC for WA and ID and ORPRN's existing network of small practices with a goal of enrolling 320 small practices out of an estimated 1,479 with stage 1 meaningful use of their electronic health record across the three states. In addition to providing health IT support for the Physician Quality Reporting System (PQRS) to measure the ABCS indicators in all practices, our comprehensive approach to building QI capacity and improving the ABCS measures consists of: 1) practice facilitation as a unifying strategy, 2) academic detailing/outreach to support implementation of PCOR findings, and 3) shared learning collaboratives. We will employ an innovative study and evaluation design by providing two levels of support for each of the latter three practice support components. By randomly assigning practices to one of eight possible combinations of practice support, we will "...develop new evidence about the contribution of various components of the comprehensive approach and the effect of the intensity of the approach on outcomes." Our rigorous mixed-method evaluation is based on the RE-AIM framework and will employ multi-level models and interrupted time series regression. Data will be collected from a control group of practices to examine secular trends. Our Specific Aims are to: 1) Identify, recruit and conduct baseline assessments in 320 small to medium size primary care practices across the geographically contiguous region of WA, OR and ID; 2) Provide comprehensive external practice support to build QI capacity within these practices; 3) Disseminate and support the adoption of PCOR findings relevant to the ABCS quality measures; 4) Conduct a rigorous evaluation of the effectiveness of providing external practice support to implement PCOR findings and improve ABCS measures; and 5) Assess the sustainability of changes made in QI capacity and ABCS improvements and develop a model of dissemination and primary care practice support infrastructure.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 209
- Primary care practice with 10 or fewer providers and an Electronic Health Record (EHR) that meets Stage 1 meaningful use criteria
- No EHR
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Site Visit Coaching Site visits made by practices to 'exemplar" practices to learn innovative approaches to quality improvement Educational Outreach and Site Visit Educational Outreach In this arm of the study, practices will be offered both educational outreach and an opportunity for a site visit Coaching Coaching External facilitation by a practice coach for 15 months Educational Outreach Coaching Academic detailing phone calls to support implementation of a cardiovascular risk calculator/estimator in each clinic Educational Outreach Educational Outreach Academic detailing phone calls to support implementation of a cardiovascular risk calculator/estimator in each clinic Site Visit Site Visits Site visits made by practices to 'exemplar" practices to learn innovative approaches to quality improvement Educational Outreach and Site Visit Coaching In this arm of the study, practices will be offered both educational outreach and an opportunity for a site visit Educational Outreach and Site Visit Site Visits In this arm of the study, practices will be offered both educational outreach and an opportunity for a site visit
- Primary Outcome Measures
Name Time Method Hypertension Every 3 months with 12 month look-back NQF 0018 Controlling hypertension
Appropriate use of Aspirin Every 3 months with 12 month look-back National Quality Forum (NQF) 0068 Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic
Smoking Every 3 months with 12 month look-back NQF 0027 Smoking and Tobacco Use Cessation, Medical Assistance
- Secondary Outcome Measures
Name Time Method Quality Improvement Capacity Assessment Baseline and 12 months Practice-level consensus agreement on QI capacity
Change Process Capacity Baseline, 15 months, 21 months The change process capacity questionnaire
Trial Locations
- Locations (1)
GroupHealthCoop
🇺🇸Seattle, Washington, United States