• Kent F Sutton, Erica L Richman, Jennifer R Rees, Liza L Pugh-Nicholson, Macie M Craft, Shannon H Peaden, Monique Mackey, Jacqueline R Halladay, and Southeastern Collaboration to Improve Blood Pressure Writing Group.
• From the University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research (KFS, ELR, JRH); Duke University School of Medicine, Durham, NC (KFS); University of North Carolina at Chapel Hill, North Carolina Translational and Clinical Sciences (JRR); University of Alabama at Birmingham, Birmingham, AL (LLP, MMC); Samford University, Birmingham, AL (LLP, SHP); East Carolina University, Greenville, NC (MM); Area L Area Health Education Center, Rocky Mount, NC (JRH).
• J Am Board Fam Med. 2021 Sep 1; 34 (5): 991-1002.

BackgroundPractice facilitation (PF) is a promising but relatively new intervention supporting data-driven practice change. There is a need to better detail research-based facilitation methods, which must balance intervention fidelity and time restrictions with the flexibility required for the intervention. As part of a multi-level 4-armed cluster randomized clinical trial (RCT), 32 rural primary care practices received PF for 1 year. We evaluated the feasibility of having facilitators guide practices to perform 4 key driver domain activities, implemented as Plan-Do-Study-Act (PDSA) cycles, to better understand facilitation "exposure." We describe the intervention and activity length such that our experiences may be useful to other PF research efforts.MethodsThirty-two practices serving rural patients involved in the Southeastern Collaboration to Improvement Blood Pressure Control engaged with a facilitator to develop and implement PDSAs nested within key drivers of change domains. Numbers of months practices worked on activities deemed most likely to be sustained were captured along with practice satisfaction data.ResultsAll practices engaged in at least 4 domain-level activities, and 59% of the PDSAs were active for at least 3 months. There was variation by domain in the average length of the PDSA activities. Ninety-seven percent (31 of 32) of practices recommended similarly structured facilitation services to other primary care practices, and 84% (27 of 32) noted substantive changes in their care processes.ConclusionIn this trial, it was feasible for PFs to engage practices in at least 4 Key Driver quality improvement activities within 1 year, which will inform PF methods and protocol development in future trials.© Copyright 2021 by the American Board of Family Medicine.

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