Characterizing the practice facilitation approach: what facilitators do and how they do it to support quality...

Area of Science:

• Health Services Research
• Quality Improvement Science
• Implementation Science

Background:

• Practice facilitation (PF) is a key strategy for improving primary care quality.
• Few frameworks detail PF in resource-limited small, independent practices (SIPs).
• Understanding PF in SIPs is crucial for effective intervention adoption.

Purpose of the Study:

• To define core PF processes and strategies in SIPs.
• To expand understanding of how PF is operationalized in small practices.
• To inform implementation of evidence-based interventions in SIPs.

Main Methods:

• Qualitative analysis of practice facilitator field notes from a stepped-wedge RCT.
• Analysis of 528 visit transcripts from 74 SIPs using a hybrid deductive-inductive approach.
• Iterative coding with team calibration and member checking.

Main Results:

• Identified an iterative PF process: observe/listen, diagnose, engage, problem-solve.
• This dynamic process improved PF understanding of practice context.
• Discovered a novel strategy: 'modeling,' where facilitators demonstrated tasks in real-time.

Conclusions:

• Refined PF frameworks for practice transformation in SIPs.
• Framework offers practical guidance for small practice settings.
• Highlights the importance of context-specific facilitation strategies.