Virtual Practice Facilitation and Implementation of Cardiovascular Quality Improvement Strategies in Primary Care...

Practice facilitation (or practice coaching) is a scientifically supported approach for improving evidence-based guideline adoption in primary care. Practice facilitation has historically occurred in person; however, the COVID-19 pandemic led to the adoption of many hybrid and virtual practice facilitation (VPF) projects. The impact of VPF on quality improvement (QI) implementation outcomes is unknown. The purpose of this study was to describe the relationship between VPF and implementation of 18 evidence-based QI strategies, based on a hybrid cardiovascular QI project in 49 primary care clinics in Michigan.

This was an exploratory study drawing on interviews and descriptive statistics. The authors conducted interviews with 5 practice facilitators (PFs) to identify their perspectives on the strategies most appropriate for VPF and perceived effects of VPF on implementation. Descriptive statistics were used to report practices' use of VPF and total implementation scores after 12 months.

Approximately 20% (62 of 304) of facilitation meetings were virtual. PFs reported that in-person facilitation was beneficial for strategies involving observation, demonstration, and workflow changes (for example, blood pressure measurement); virtual facilitation was appropriate for strategies involving information sharing (for example, referrals to quit line). Practices that received some or all of their QI time virtually showed a larger increase in total implementation score after one year, compared to those who received all visits in person.

Some QI strategies, particularly those involving information sharing, may be well suited to VPF, while others that require observation or workflow change may benefit from in-person support. Practices that used at least some VPF showed greater improvements in implementation scores, though future research is needed to more rigorously assess how facilitation modality relates to implementation outcomes.