domingo, 21 de junio de 2015

| AHRQ Health Care Innovations Exchange ► New Curriculum Aims to Expand Access to Primary Care Practice Facilitation

| AHRQ Health Care Innovations Exchange

AHRQ Innovations Exchange: Innovations and Tools to Improve Quality and Reduce Disparities

New Curriculum Aims to Expand Access to Primary Care Practice Facilitation

by the Innovations Exchange Team

Primary care practice facilitation is a field that is gaining prominence as a way to support practices as they engage in quality improvement activities and transition to the patient-centered medical home and other new primary care delivery models. Increasingly, primary care practices recognize that they need expert advice and ongoing support in order to transform care delivery and improve patient outcomes. To help meet this need, the Agency for Healthcare Research and Quality (AHRQ) has been developing resources to help train practice facilitators, who are also called practice coaches, quality improvement coaches, or practice enhancement assistants. The soon-to-be-released AHRQ Primary Care Practice Facilitation Curriculum is the latest addition to an AHRQ portfolio of products that support the growth of practice facilitation, so that more primary care practices and their patients can benefit from the expertise of a practice facilitator.
To learn about AHRQ’s work in this area and the emerging role of practice facilitators, the Innovations Exchange interviewed Bob McNellis, Senior Advisor for Primary Care at AHRQ, and Jan Genevro, Health Scientist in the Center for Evidence and Practice Improvement at AHRQ.
Innovations Exchange: Why has AHRQ developed a new curriculum for practice facilitation training?
Bob McNellis, MPH, PA: Based on AHRQ’s work over the past 5 years, we knew there was a growing demand for practice facilitation—a process that can help practices make meaningful changes to improve the quality and experience of care for patients and clinicians—especially in the context of value-based purchasing and quality measurement. In general, clinicians don’t receive much training in quality improvement techniques, so there’s a need for practice facilitators who can provide the expertise and tools required to implement effective quality improvement processes in primary care settings. We wanted to offer a resource that any organization could use to build a training program that can help meet the demand for practice facilitators.
We’ve taken the previously developed AHRQ Practice Facilitation Handbook to the next level by developing an expanded core curriculum that provides a uniform educational approach to training practice facilitators. We added background information about the primary care landscape, new modules on practical approaches to working with practices, more resources for students and instructors, and a guide on how to use the curriculum and apply the principles of adult education to training activities. The curriculum was authored by leaders in the field and guided by a technical expert panel that provided input about the curriculum from beginning to end.
What kinds of organizations do you expect will use the curriculum?
McNellis: We designed this curriculum to be useful to a wide variety of organizations interested in building practice facilitation training programs. Potential users include quality improvement organizations, health systems, independent practice associations, community health centers, professional associations, community colleges and other academic institutions, payers, and government agencies.
What professional experience is helpful for people seeking training to become practice facilitators?
Janice L. Genevro, PhD: People who seek such training come from a variety of backgrounds, including registered nurses, public health specialists, social workers, and health information technology professionals. The practice facilitator must be able to develop a trusting relationship with practices, and as part of the process of achieving quality improvement goals, help clinicians and staff make changes in the way they work—changes that can be quite challenging. A practice facilitator won’t necessarily have expertise in all of the areas that are important for practice transformation and might bring in a consultant who can provide guidance to a practice on financial management, health information technology, or other special topic areas.
McNellis: We sometimes say that practice facilitators are like clinicians for medical practices. They focus on helping health care professionals change their behavior and environment in order to achieve quality improvement goals. Practice facilitation programs sometimes rely on teams to meet the needs of medical practices. Similar to the process of providing care for a patient, it is advantageous for a medical practice to have access to members of a practice facilitation team that includes people with diverse professional expertise. Then the entire team can contribute to the success of the facilitation effort—whether that means managing data better, building a functional electronic health record system, or revising workflows—and the practice can have access to the right expertise at the right time.
Can you say a bit about the development of the field of practice facilitation?
McNellis: The role of the practice facilitator has been recognized in the United States since the early 1990s, and the discipline has even earlier origins in the United Kingdom and other countries. The term practice coaching was a favored term for many years, but practice facilitation has gained currency for describing the process of providing ongoing support to help primary care practices achieve substantive changes in care delivery. The role of the facilitator is to provide guidance and to recommend approaches that are based on an assessment of each practice’s strengths, weaknesses, and goals. Much of the practice facilitator’s work hinges on developing effective and lasting relationships with health care professionals aimed at achieving each practice’s goals. Most studies of practice facilitation outcomes have shown positive effects on the adoption of evidence-based practices and other quality indicators.
Genevro: Practice-based research networks in particular have long been committed to innovations in quality improvement. The leaders of these networks have continued to do a lot to develop the field of practice facilitation.
What are the economics of practice facilitation in the United States?
McNellis: Making meaningful and sustainable changes in care delivery requires a long-term commitment on the part of practices and development of trusted relationships with practice facilitators. Most practices would find it difficult to pay for ongoing access to a practice facilitator without an external funding source. Practice facilitation has been most successful when the service is provided as part of a national demonstration project or a State initiative, such as in North Carolina or Pennsylvania. Many practice facilitation programs are funded through Federal grants and contracts, foundation grants, funding from State Medicaid or Medicare programs, and health plans. Other models for supporting practice facilitation include regional health information technology extension centers, practice-based research networks and, as in Colorado and Washington, State-funded extension services. Few programs are funded by direct payment by practices themselves, although future changes in financial incentives may make that a viable option.
Genevro: Research grants that include a quality improvement component also have provided a pathway for funding practice facilitation. But there is a lot of concern about how to secure ongoing support for practice facilitation after grant funding ends. One model that might work involves creating a mechanism for private insurers or other payers to provide compensation to practices to support practice facilitators. This model would allow practices to pay for ancillary services by using part of their per-patient, per-month payments.
How do you see the current size and potential growth of the field of practice facilitation?
McNellis: We don’t have precise figures, but we estimate that there might be several thousand practice facilitators working in the United States. The expanding e-mail listserv for AHRQ’s Primary Care Practice Facilitation Learning Community has surpassed 1,700 subscribers. Assuming that an individual practice facilitator can work with only 15 to 20 practices at a given time, it’s likely that there remains a large unmet need for more facilitators to serve primary care practices.
Genevro: We see an opportunity for tremendous growth of the field of primary care practice facilitation. Compared with hospitals, primary care practices are still in the early stages of quality improvement activities, partly because there isn’t really a primary care “system” to support quality improvement efforts in small and widely dispersed practices. Continued expansion of practice facilitation will hinge on further development of the infrastructure that supports quality improvement activities in primary care.

About Bob McNellis, MPH, PA: Mr. McNellis is Senior Advisor for Primary Care at the Agency for Healthcare Research and Quality.
About Janice L. Genevro, PhD: Dr. Genevro is a Health Scientist in the Center for Evidence and Practice Improvement at the Agency for Healthcare Research and Quality. She has led AHRQ’s work on the patient-centered medical home over the past 6 years, including the development of the PCMH Resource Center Web site.
Disclosure Statements:
Dr. Genevro and Mr. McNellis reported having no financial interests or business/professional affiliations that are relevant to the work described in this article.

Suggested Reading
Implementing the PCMH: Practice Facilitation. Agency for Healthcare Research and Quality.
Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators.Agency for Healthcare Research and Quality.
Practice Enhancement Assistants Improve Quality of Care in Primary Care Practices. Innovation Profile. Agency for Healthcare Research and Quality.
Practice Facilitation Handbook: Training Modules for New Facilitators and Their Trainers. QualityTool. Agency for Healthcare Research and Quality.
Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide. QualityTool. Agency for Healthcare Research and Quality.
Integrating Chronic Care and Business Strategies in the Safety Net: A Practice Coaching Manual. QualityTool. Agency for Healthcare Research and Quality.
Integrating Chronic Care and Business Strategies in the Safety Net: A Toolkit for Primary Care Practices and Clinics. QualityTool. Agency for Healthcare Research and Quality.

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