Effective Facilitator Strategies for Supporting Primary Care Practice Change: A Mixed Methods Study.

Area of Science:

• Implementation Science
• Healthcare Quality Improvement
• Primary Care Research

Background:

• Practice facilitation is a key strategy for implementing evidence-based practices in healthcare.
• Identifying factors that enhance facilitator effectiveness is crucial for successful quality improvement initiatives.
• Large-scale studies are needed to understand the nuances of effective facilitation.

Purpose of the Study:

• To identify specific strategies employed by more effective practice facilitators in a large-scale quality improvement initiative.
• To differentiate the approaches of effective versus less effective facilitators in primary care settings.
• To inform the development of training programs for practice facilitators.

Main Methods:

• A sequential mixed methods study analyzed data from the EvidenceNOW initiative, involving 162 facilitators and 1,630 primary care practices.
• Facilitator effectiveness was defined based on the percentage of practices achieving improvements in aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity.
• Observational and interview data were analyzed using an immersion crystallization and comparative approach.

Main Results:

• Practices with more effective facilitators showed a 3.6% greater improvement in the composite ABS measure compared to those with less effective facilitators (P <.001).
• More effective facilitators tailored QI work, addressed resistance, fostered critical thinking, and provided accountability.
• Effective facilitators described their work in detail, unlike less effective facilitators who used general terms.

Conclusions:

• Specific facilitation strategies, including tailoring, addressing resistance, critical thinking guidance, and accountability, distinguish effective facilitators.
• These findings have direct implications for improving facilitator training and development.
• Enhancing these strategies can optimize the support provided to practices for implementing changes.