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Attributes of High-Performing Small Practices in a Guideline Implementation: A Multiple-Case Study.

Ann M Nguyen1, Allison M Cuthel2, Erin S Rogers2

  • 1Rutgers University, New Brunswick, NJ, USA.

Journal of Primary Care & Community Health
|December 28, 2020
PubMed
Summary

Small primary care practices that effectively adopted cardiovascular disease guidelines used advanced EHR, had dedicated quality improvement resources, and engaged leadership. These factors indicate readiness for practice facilitation interventions.

Keywords:
case studymixed methodspractice transformationprimary carequalitative methods

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Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Quality Improvement Science

Background:

  • The HealthyHearts NYC trial investigated practice facilitation for cardiovascular disease guideline adoption in small primary care settings.
  • Understanding factors influencing successful intervention implementation in small practices is crucial for improving patient care.

Purpose of the Study:

  • To identify attributes of small primary care practices that predict successful implementation of practice facilitation interventions.
  • To determine characteristics associated with high performance in adopting cardiovascular disease guidelines.

Main Methods:

  • A mixed-methods multiple-case study design was employed, analyzing six small practices.
  • Practices were selected based on their performance in managing hypertensive patients.
  • Inductive and deductive thematic analysis and cross-case comparison were used to identify performance determinants.

Main Results:

  • High-performing practices exhibited similar behaviors during intervention implementation.
  • Key attributes identified included advanced electronic health record (EHR) utilization, dedicated quality improvement resources and commitment, and active engagement from lead clinicians and office managers.

Conclusions:

  • Advanced EHR use, commitment to quality improvement, and engaged leadership are critical attributes for high performance in small practices undergoing interventions.
  • These attributes may signify a practice's capability and readiness for change, suggesting a need for tools to assess this readiness in small primary care settings.