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

Theresa L Walunas,Jennifer Bannon,Abel N Kho,Nicholas Soulakis,Ann Wang,Justin D Smith,Jiancheng Ye

doi:10.1186/s13012-021-01100-8

Abstract

BackgroundPractice 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.MethodsWe 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.ResultsThere 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.ConclusionsPractices 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.

Highlights

Practice facilitation is a multicomponent implementation strategy used to improve the capacity for practices to address care quality and implementation gaps
It is possible to develop an informatics-driven framework and terminology system that can be used for cross-study comparison of the impact of practice facilitation strategies on intervention implementation across diverse practice settings
While previous reviews have shown a relationship between practice facilitation intensity and outcomes [8, 9], it remains to be determined which approaches are most conducive to successful practice transformation and what data elements are most essential for evaluation of practice facilitation strategies and activities and development of models to better understand the interplay of practice facilitators and practices in quality improvement success

Summary

Introduction

Few conceptual frameworks or standardized terminologies exist to describe the specific implementation strategies constituting practice facilitation Such a framework is needed to support comparison of practice facilitation within and across initiatives. The lack of such a framework renders it difficult to ascertain which facilitation strategies are broadly useful for sustained implementation of QI and other interventions. There is a need to open the “black box” of practice facilitation to better understand the active ingredients of this strategy that are responsible for the observed positive changes. From this line of inquiry, better understanding of the mechanisms of action are possible

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Discussion

Conclusion