Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in...

Area of Science:

• Implementation Science
• Healthcare Management
• Chronic Disease Management

Background:

• Community practices often struggle with implementing complex care models.
• Low-level implementation support may be insufficient for certain practices.
• External facilitation (EF) is a common strategy to support practice change.

Purpose of the Study:

• To compare the effectiveness of external facilitation (EF) versus combined external and internal facilitation (EF/IF).
• To assess the impact of facilitation strategies on the uptake of a collaborative chronic care model (CCM).
• To identify factors moderating the effectiveness of different facilitation approaches in community practices.

Main Methods:

• 43 community practices were randomized after initial low-level support.
• Practices were assigned to either EF or EF/IF for 12 months.
• Outcomes measured included the number of patients receiving the CCM and a clinically significant dose of the CCM.

Main Results:

• EF/IF showed greater CCM uptake than EF overall (4.4 more patients).
• EF/IF significantly benefited nonadopter sites (9.2 more patients).
• Adopter sites showed no significant difference in uptake between EF and EF/IF.

Conclusions:

• Intensified facilitation (EF/IF) can improve CCM uptake, but primarily in practices with no prior adoption.
• For practices with existing CCM delivery, additional internal facilitation may not enhance implementation efforts.
• Implementation support should be tailored based on practice readiness and prior adoption levels.