Implementation Strategies Used by Facilitators to Improve Control of Cardiovascular Risk Factors in Primary Care.

Abstract

Practice facilitation supports practice change in clinical settings. Despite its widespread use little is known about how facilitators enable change. This study identifies which implementation strategies practice facilitators used and the frequency of their use in a study to improve the quality of cardiovascular care in primary care. Cross-sectional analysis of data collected by practice facilitators in the Healthy Hearts Northwest (H2N) study. Notes collected by facilitators in the H2N study. We coded these field notes for a purposeful sample of 44 practices to identify Expert Recommendations for Implementation Change (ERIC) strategies used with each practice and calculated the proportion of practices where each implementation strategy was coded at least once. Strategies were categorized as foundational (used in 80% to 100% of practices), moderately used (20%-<80% of practices), rarely used (1-[Formula: see text]% of practices), or absent (0%). We identified 26 strategies used by facilitators. Five strategies were foundational: Develop and/or implement tools for quality monitoring, Assess barriers that may impede implementation, Assess for readiness or progress, Develop and support teams, and Conduct educational meetings. Commonly used strategies can help guide development of the core components of practice facilitation strategies.