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Quality improvement practice coaches for primary care

Health Factors: Quality of Care
Decision Makers: Healthcare Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Practice coaches or facilitators work with clinic staff to redesign clinical practices and improve the quality of care they deliver. Efforts can center around ensuring care timeliness, increasing practice efficiency and patient-centeredness, improving continuity of care, and improving preventive and chronic care (CWF-Grumbach 2012). To improve care quality, coaches organize quality improvement (QI) efforts, help staff understand and use data to drive QI (Taylor 2013b), use team-building exercises to improve communication, share best practices, and explain how other organizations have improved care. They also help motivate interest in change, and help practices choose goals, adopt new work processes, interactively solve process problems, and incorporate health information technology (AHRQ-Coleman 2009).

Expected Beneficial Outcomes

Increased practice of evidence-based medicine
Increased quality improvement activities
Improved care for chronic conditions
Improved preventive care
Improved work environment

Evidence of Effectiveness

There is strong evidence that primary care practices that work with practice coaches adopt more evidence-based guidelines than practices that have not engaged coaches (Baskerville 2012, CWF-Grumbach 2012). Coaching also increases the number of quality improvement (QI) initiatives that practices undertake (CWF-Grumbach 2012, Baskerville 2012).

Interventions that are more time intensive and those tailored to practice context and needs appear to yield stronger effects than weaker or more generic interventions (Baskerville 2012). However, additional research is needed to determine the most effective coaching models (CWF-Grumbach 2012).

Practices that work with coaches appear to deliver more preventive services than practices that do not. Coaching can improve care for chronic conditions such as diabetes and asthma, and lead to increases in teamwork, an improved work environment, and a more learning-focused culture (CWF-Grumbach 2012).

In general, quality improvement efforts that use data, specific targets, tools such as Plan-Do-Study-Act, and a long, sustained process are associated with greater success than QI efforts that do not. Strong team leadership and a culture that supports QI are also associated with successful efforts (Kaplan 2010).

Practice coaching can cost from $7,500 to $60,000 depending on project goals, coaching and intervention design, and travel expenses (AHRQ-Knox 2011). 

Implementation

United States

Practice coaching is growing in the United States and globally (AHRQ-Knox 2011). Coaching is often funded through federal programs such as Area Health Education Centers (AHEC), Health Information Technology for Economic and Clinical Health (HITECH) Regional Extension Centers, state governments, Medicaid waivers, and philanthropic organizations (Taylor 2013). In 2011, the Agency for Healthcare Research and Quality (AHRQ) granted Oklahoma, North Carolina, New Mexico, and Pennsylvania funding to assist primary care clinics with practice facilitation (Taylor 2013).

Wisconsin

From 2008 to 2010, 14 small Wisconsin primary care practices participated in the Improving Performance in Practice (IPIP) initiative and received tools and coaching to evaluate performance and implement quality improvement activities (WCHQ-IPIP). 

Implementation Resources

AF4Q 2014 - Aligning Forces for Quality (AF4Q). Practice coaching: What is a practice coach? Accessed on March 1, 2016
AHRQ-PF - Agency for Healthcare Research and Quality (AHRQ). Implementing the PCMH: Practice facilitation. Patient centered medical home (PCMH) resources. Accessed on March 14, 2016
AHRQ-Taylor 2014 - Taylor EF, Peikes D, Geonnotti K, et al. Quality improvement in primary care: External supports for practices. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014. Accessed on March 3, 2016

Citations - Description

AHRQ-Coleman 2009 - Coleman K, Pearson M, Wu S. Integrating chronic care and business strategies in the safety net: A practice coaching manual. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2009. Accessed on March 2, 2016
CWF-Grumbach 2012 - Grumbach K. Facilitating improvement in primary care: The promise of practice coaching. New York: The Commonwealth Fund (CWF); 2012: Issue Brief. Accessed on March 14, 2016
Taylor 2013b - Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN. Enhancing the primary care team to provide redesigned care: The roles of practice facilitators and care managers. Annals of Family Medicine. 2013;11(1), 80-;83. Accessed on February 29, 2016

Citations - Evidence

AHRQ-Knox 2011 - Knox L, Taylor E, Geonnotti K, et al. Developing and running a primary care practice facilitation program: A how-to guide. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2011. Accessed on March 3, 2016
Baskerville 2012 - Baskerville N, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Annals of Family Medicine. 2012;10(1), 63-74. Accessed on March 1, 2016
CWF-Grumbach 2012 - Grumbach K. Facilitating improvement in primary care: The promise of practice coaching. New York: The Commonwealth Fund (CWF); 2012: Issue Brief. Accessed on March 14, 2016
Kaplan 2010* - Kaplan H, Brady P, Dritz M, et al. The influence of context on quality improvement success in health care: A systematic review of the literature. Milbank Quarterly, 2010;88(4), 500-559. Accessed on March 2, 2016

Citations - Implementation

AHRQ-Knox 2011 - Knox L, Taylor E, Geonnotti K, et al. Developing and running a primary care practice facilitation program: A how-to guide. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2011. Accessed on March 3, 2016
Taylor 2013 - Taylor JC, Johnson RK. Farm to school as a strategy to increase children's fruit and vegetable consumption in the United States: Research and recommendations. Nutrition Bulletin. 2013;38(1):70-9. Accessed on November 9, 2015
WCHQ-IPIP - Wisconsin Collaborative for Healthcare Quality (WCHQ). Improving performance in practice (IPIP). Accessed on February 29, 2016

Page Last Updated

July 29, 2015

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