The Role of Practice Facilitators in Meeting the Health Information Technology Needs of Rural Practices
Principal Investigators: Ann Lefebvre, MSW, CPHQ; Mary McCaskill; Kristin Reiter, PhD; Jason Mose, MS, MBA, CHFP, PhD; Erin P. Fraher, PhD; Warren P. Newton, MD, MPH
Background. Primary care transformation is necessary for health system redesign, but how to support this on a large scale remains unclear. The tasks of contemporary primary care are substantial, and include closing the quality gap and addressing disparities, while lowering total cost of care and increasing patient engagement. At the same, the clinical and organizational environment for primary care has become increasingly challenging, the result of Medicaid expansion, practice acquisition, electronic health record (EHR) adoption and changes, meaningful use and (Physician Quality Reporting System) PQRS, commercial insurance incentive plans, ICD 10 and many new developments such as the development of the Medical Scientist Partnership Program (MSPP) and clinically integrated networks.
Practice facilitators—also called practice support coaches or quality improvement coaches—are one possible solution. There is ample evidence from research and demonstration projects that practice facilitation can improve quality, access to care and patient satisfaction and health care systems and other organizations are beginning to implement practice coaching programs. Virtually all published experience, however, is in the context of single trials or demonstrations of limited scope and duration and we do not have a detailed picture of practice facilitators as the role has broadened and matured and the clinical environment has evolved.
This case study of North Carolina’s practice facilitation program examined the level of skills and knowledge practice facilitators possess and their effectiveness in helping small, rural practices meet the demands of using health information technology. Specifically, this study described the practice facilitator profession and assessed its economic value to primary care practices, using a successful, stable, not-for-profit statewide model as a benchmark and focusing on meaningful use Stage 1 and NCQA patient-centered medical home (PCMH) recognition as examples of national recognition programs.
Research Questions:
- What background or skills did the NC AHEC practice facilitators possess upon hiring?
- How did practice facilitators rate their knowledge on key skills required to help practices achieve Stage 1 or Stage 2 of the Meaningful Use program?
- Was practice facilitation associated with better provider performance on selected quality, safety and efficiency, care coordination and patient engagement measures under modified Stage 2 of Meaningful Use?
Methods. The practice support program of the NC AHEC Program has supported more than 1200 primary care practices over the past 10 years. With funding from the Office of the National Coordinator, the CDC, the Robert Wood Johnson Foundation, and Agency for Healthcare Research and Quality (AHRQ), the NC AHEC Program has successfully incorporated the functions of the Regional Extension Center for health information technology (HIT) into a broader program to support practices along a continuum of transformation that goes beyond simply adopting HIT and into helping practices to meaningfully use their EHR systems to improve their care delivery, track and respond to patient outcomes and to fully transform into a patient centered medical home. The program is statewide, with 9 regional offices; it is a public non-profit utility and works with many different community partners. The NC AHEC practice support program employs 43 practice coaches organized in regional teams with a variety of skills, and has formal on-boarding training, ongoing professional development and regular assessments of performance. NC AHEC Practice Support has demonstrated significant improvement in quality of care and has supported over 1200 primary care practices s in meeting meaningful use.
To describe the role and function of practice coaches, the study team surveyed the NC AHEC practice coaches about their prior professional training and experience, current role, core competencies and ongoing professional development. The survey was supplemented with selected focus group sessions and individual interviews comparing more experienced and less experienced coaches and those with better outcomes to those without. Selected focus group interviews were conducted with stakeholders—different kinds of practices working with coaches—private practices, acquired practices, Federally Qualified Health Centers (FQHCs), health departments and free clinics. Analysis included evaluation of transcriptions with an immersion/crystallization approach and triangulation via interviews with practice support program leaders and the coaches themselves.
- Lefebvre A, McCaskill M, Reiter K, Mose J, Fraher E, Newton W. The Role of Practice Facilitators in Meeting the HIT Needs of Rural Practices. Policy Brief. Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research. January 2017.
- Lefebvre A, McCaskill M, Reiter K, Mose J, Fraher E, Newton W. 2017 January. The role of practice facilitators in meeting the HIT needs of rural practices. Carolina Health Workforce Research Center. Abstract.