JMIR Publications

ABSTRACT

Background:

The past decade has seen increasing opportunities and efforts to integrate quality improvement (QI) into healthcare. Practice facilitation is a proven supportive service and approach to support redesign and improvement in primary care practices that focus on building organizational capacity for continuous improvement. Practice leadership, staff, and practice facilitators all play important roles in supporting primary care in performing QI. However, little is known about their perspectives on the context, enablers, barriers, and strategies that facilitate success and areas of agreement and disagreement, which may provide insights for future QI initiatives.

Objective:

To design and develop a framework that identifies contextual factors, challenges, and strategies that impact practice facilitation, clinical measure performance, and implementation of QI interventions. We also aim to illustrate the application of this framework using a real-world case study.

Methods:

We developed the TITO (Task, Individual, Technology, and Organization) framework to identify enablers and barriers to QI practice facilitation. We performed a case study using a mixed-methods approach to demonstrate the use of the framework and describe practice facilitation and factors that impact QI in a primary care practice enrolled in the Healthy Hearts in the Heartland (H3) initiative.

Results:

The proposed TITO framework was developed to organize and analyze different stakeholders’ perspectives and key factors. Our findings show that the three stakeholder groups -- practice leaders, staff, and practice facilitators -- all influenced the success of QI initiatives. However, they faced different challenges and used different strategies during the practice facilitation. Based on the proposed framework, barriers mainly stemmed from patients’ social determinants of health (SDOH), lack of staff/time, and unsystematic facilitation resources. Experiences in facilitating the improvement include practice culture, staff buy-in, practice facilitator’s effective strategies, practice’s willingness and capacity to make change, and shared complementary resources from similar ongoing programs.

Conclusions:

The proposed framework and case study support a better understanding of the contextual factors for practice facilitation and therefore enable well prepared and more successful QI programs for primary care practices. The practice leader, staff, and practice facilitator all saw value in the QI practice facilitation. Practice facilitators are key liaisons in the QI program to help all stakeholders work toward a shared target leveraging tailored strategies. Taking advantage of the resources from competing programs that complement each other as additional support can accelerate the efficacy and effectiveness of achieving QI goals. Practice facilitation–supported QI program may be opportunities to assist primary care practices in achieving improved quality of care through focused and targeted efforts. The TITO framework would be a useful and generalizable guideline for future practice facilitation projects, QI initiatives, health care intervention implementation studies to organize and analyze the complex and interacting factors that impact the success of the program. Clinical Trial: N/A