Primary Care Improvement Infrastructure: The Role of Practice Facilitation Michael L. Parchman, MD MPH MacColl Center for Health Care Innovation AHRQ Annual Scientific Session September 2012

HHS: National Quality Strategy First effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States. First effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States. Designed to be an evolving guide for the nation Designed to be an evolving guide for the nation Developed both through evidence-based results of the latest research and a collaborative transparent process that included input from a wide range of stakeholders Developed both through evidence-based results of the latest research and a collaborative transparent process that included input from a wide range of stakeholders AHRQ Annual Scientific Session September 2012

National Quality Strategy: 3 Aims Better Care: Better Care: Improve overall quality, making care more patient- centered, reliable, accessible and safe Improve overall quality, making care more patient- centered, reliable, accessible and safe Healthy People and Communities: Healthy People and Communities: Support proven interventions to address behavioral, social and environment determinants of health Support proven interventions to address behavioral, social and environment determinants of health Affordable Care Affordable Care Reduce the cost of quality health care for individuals, families, employers and government Reduce the cost of quality health care for individuals, families, employers and government AHRQ Annual Scientific Session September 2012

NQS: Six Priorities 1. Safer care by reducing harm caused in care delivery 2. Patients & families engaged as partners in care 3. Effective communication & coordination 4. Use of effective prevention and treatment practices for leading cause of mortality starting with cardiovascular disease AHRQ Annual Scientific Session September 2012

NQS: 6 Priorities (continued) 5. Work with communities to support wide use of best practices to enable healthy living 6. Make quality of care more affordable by developing and spreading new care delivery models AHRQ Annual Scientific Session September 2012

NQS Principles 1. Person-centeredness and family engagement 2. Specific health considerations 3. Eliminating disparities in care 4. Aligning the efforts of public and private sector 5. Quality improvement 6. Consistent national standards 7. Primary care will become a bigger focus 8. Coordination will be enhanced 9. Integration of care delivery 10. Providing clear information AHRQ Annual Scientific Session September 2012

The Problem Hospital QI Infrastructure* Hospital QI Infrastructure* $2 million to $21 million per year per hospital $2 million to $21 million per year per hospital 1-2% of total operating revenue 1-2% of total operating revenue $200 to $400 per discharge $200 to $400 per discharge Primary Care QI Infrastructure Primary Care QI Infrastructure ?????? ?????? *Chen LM, et al. Costs of quality improvement: a survey of four acute hospitals. Jt Comm J Qual & Pt Safety 2009 AHRQ Annual Scientific Session September 2012

The Role of Practice Facilitation Practice facilitators are specially trained individuals who work with primary care practices “to make meaningful changes designed to improve patients’ outcomes. [They] help physicians and improvement teams develop the skills they need to adapt clinical evidence to the specific circumstance of their practice environment” Practice facilitators are specially trained individuals who work with primary care practices “to make meaningful changes designed to improve patients’ outcomes. [They] help physicians and improvement teams develop the skills they need to adapt clinical evidence to the specific circumstance of their practice environment” DeWalt D, Powell J, Mainwaring B, et al. Practice coaching program manual. Princeton, NJ: Aligning Forces for Quality (AF4Q), George Washington University Medical Center; AHRQ Annual Scientific Session September 2012

The Intersection of NQS and PF NQS Priority #4: “Use of effective prevention and treatment practices for leading cause of mortality starting with cardiovascular disease” NQS Priority #4: “Use of effective prevention and treatment practices for leading cause of mortality starting with cardiovascular disease” Primary care practices are almost three times as likely to adopt evidence-based guidelines through PF compared with no-intervention control group practices Primary care practices are almost three times as likely to adopt evidence-based guidelines through PF compared with no-intervention control group practices Baskerville, Hogg, and Liddy, Ann Fam Med AHRQ Annual Scientific Session September 2012

Intersection of NQS and PF An effective and efficient way to deliver the training and support needed for different types of primary care practices across the country to transform into medical homes and other forms of primary care redesign. An effective and efficient way to deliver the training and support needed for different types of primary care practices across the country to transform into medical homes and other forms of primary care redesign. Facilitators build permanent capacity for continuous quality improvement and establish sustained relationships with practices that can be activated efficiently and rapidly speed adoption of new treatments and models of care as they are discovered in the future. Facilitators build permanent capacity for continuous quality improvement and establish sustained relationships with practices that can be activated efficiently and rapidly speed adoption of new treatments and models of care as they are discovered in the future. AHRQ Annual Scientific Session September 2012

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