Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension.

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services

Factors Associated With Use of Quality Improvement Strategies Among Small-to Medium Size Primary Care Practices in the United States.

Context: Improving health care quality in small-to-medium-size primary care practices, where the majority of Americans receive care, is a national priority, but little is known about these practices\u27 ability to use quality improvement (QI) strategies to deliver high quality care. Objective: To examine variations in the use of QI strategies across small-to-medium primary care practices and to assess practice-level factors associated with variations. Design: Cross-sectional study. Multivariable linear regression was used to examine the independent relationship between practice characteristics and the use of QI strategies as measured by the strategies scale of the Change Process Capability Questionnaire (CPCQ), a validated instrument designed to measure practice use of QI strategies. Setting: Data from 1,091 small-to-medium-size practices (≤10 clinicians) in 12 US states engaged in a national initiative to improve quality of care for heart health. Participants: Survey of practice leaders to assess practices characteristics and use of improvement strategies. Results: Of the practices surveyed, 84% had 10 or fewer clinicians, 21% had experienced multiple disruptive changes in the prior year, and most had meaningful use-certified electronic health records. Mean CPCQ strategies score was 8.6 (range -28 to +28, SD=12.2). Mean CPCQ scores were higher for practices that were part of accountable care organizations (+2.06, p=0.006) or had participated in demonstration projects (+1.59, p=0.04). Also, practices that discussed clinical quality data during meetings, that had someone in practice to configure EHR quality reports, and that had produced quality reports at least once in the prior six months had higher CPCQ strategies scores. Practices experiencing major disruptive changes had lower mean CPCQ scores (-3.0, p=0.001). Conclusion: Use of QI strategies varied greatly among small-to-medium-size primary care practices. Findings suggest that strengthening organizational makeup, increasing practice EHR capabilities and reducing organizational disruption could enhance the quality of care delivered by small-to-medium-size practic