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Author Notes:

Correspondence: Michael L Parchman; parchman.m@ghc.org

Authors’ contributions: MP designed the study and led the study team through all phases of the research.

PN participated in the implementation of the study protocol, assisted with development of survey instruments, analysis of the data, interpretation of results, and assisted with manuscript preparation.

SC participated in designing the data collection methods and contributed to modification of the intervention, analysis and interpretation of results, and contributed to writing of the manuscript.

HL and LL both participated in adapting the intervention to the study sites, interpretation of results and writing of the manuscript.

See publication for full list of author contributions.

Acknowledgements: We would like to express our appreciation to the physicians and offices staff in the South Texas Ambulatory Research Network (STARNet) for their participation in this study.

Disclosures: This study received approval for human subjects research from the institutional review board of the University of Texas Health Science Center at San Antonio.

The authors declare that they have no competing interests.

The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

Subjects:

Research Funding:

This study was funded by a grant from the National Institute of Diabetes, Digestive, and Kidney Disorders (R18 DK 075692), follows the Consolidated Standards of Reporting Trials guidelines, and is registered per International Committee of Medical Journal Editors guidelines (Clinical Trial Registration Number NCT00482768).

This work was also supported with resources and the use of facilities at the Audie L. Murphy Veterans Hospital, Veterans Health Administration, Department of Veterans Affairs.

A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects

Tools:

Journal Title:

Implementation Science

Volume:

Volume 8, Number 1

Publisher:

, Pages 93-None

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Practice facilitation (PF) is an implementation strategy now commonly used in primary care settings for improvement initiatives. PF occurs when a trained external facilitator engages and supports the practice in its change efforts. The purpose of this group-randomized trial is to assess PF as an intervention to improve the delivery of chronic illness care in primary care. Methods: A randomized trial of 40 small primary care practices who were randomized to an initial or a delayed intervention (control) group. Trained practice facilitators worked with each practice for one year to implement tailored changes to improve delivery of diabetes care within the Chronic Care Model framework. The Assessment of Chronic Illness Care (ACIC) survey was administered at baseline and at one-year intervals to clinicians and staff in both groups of practices. Repeated-measures analyses of variance were used to assess the main effects (mean differences between groups) and the within-group change over time. Results: There was significant improvement in ACIC scores (p < 0.05) within initial intervention practices, from 5.58 (SD 1.89) to 6.33 (SD 1.50), compared to the delayed intervention (control) practices where there was a small decline, from 5.56 (SD 1.54) to 5.27 (SD 1.62). The increase in ACIC scores was sustained one year after withdrawal of the PF intervention in the initial intervention group, from 6.33 (SD 1.50) to 6.60 (SD 1.94), and improved in the delayed intervention (control) practices during their one year of PF intervention, from 5.27 (SD 1.62) to 5.99 (SD 1.75). Conclusions: Practice facilitation resulted in a significant and sustained improvement in delivery of care consistent with the CCM as reported by those involved in direct patient care in small primary care practices. The impact of the observed change on clinical outcomes remains uncertain. Trial registration: This protocol followed the CONSORT guidelines and is registered per ICMJE guidelines: Clinical Trial Registration Number: NCT00482768.

Copyright information:

© 2013 Parchman et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (http://creativecommons.org/licenses/by/2.0/).

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