• Bonnie T Jortberg, Douglas H Fernald, Danielle M Hessler, L Miriam Dickinson, Robyn Wearner, Lauri Connelly, Holtrop Jodi Summers JS From Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (BTJ, DHF, LMD, RW, LC, JSH, WPD); Department of Family , Lawrence Fisher, and W Perry Dickinson.
• From Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (BTJ, DHF, LMD, RW, LC, JSH, WPD); Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA (DMH, LF). bonnie.jortberg@ucdenver.edu.
• J Am Board Fam Med. 2019 May 1; 32 (3): 329-340.

BackgroundAdvanced primary care models emphasize patient-centered care, including self-management support (SMS). This study aimed to promote the translation of SMS into primary care practices and reported on key baseline practice characteristics that may impact SMS implementation.MethodsThirty-six practices in Colorado and California participated in the study from December 2013 to March 2017. Practice administrators completed a Practice Information Form describing practice characteristics. Clinicians and staff (n = 716) completed the Practice Culture Assessment and the Patient-Centered Medical Home (PCMH) Monitor. Descriptive statistics were computed to determine practice characteristics related to culture, quality improvement, level of PCMH, and SMS implementation. Field notes and key informant interviews provided contextual details about practices. Iterative qualitative analyses identified important facilitators and barriers and change capabilities around SMS implementation.ResultsIn bivariate analyses, rural locations, fewer uncontrolled patients with diabetes, higher Medicaid or uninsured populations, underserved designation, and higher level of "PCMHness" were associated with greater reported implementation of patient SMS (all P < .05) at baseline. In the final multilevel model, specialty (FM vs mixed, P = .0081), rural location (P = .0109), and higher percent Medicaid (P < .0001) were associated with greater SMS. Practices described key facilitators (alignment, motivation, a visible champion, supporting infrastructure, and functional quality improvement and care teams) and barriers (no shared vision, no visible champion, siloed infrastructure, competing programs, turnover, and time constraints) to improving SMS delivery.ConclusionsCareful attention-and action-on key practice characteristics and context may create more favorable initial conditions for practice change efforts to improve SMS in primary care practices.© Copyright 2019 by the American Board of Family Medicine.

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