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Randomized Controlled Trial
. 2020 Apr;58(4):344-351.
doi: 10.1097/MLR.0000000000001260.

Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care: A Practice-randomized, Comparative Effectiveness Trial

Stephen D Persell  1   2 , David T Liss  1   2 , Theresa L Walunas  1   3 , Jody D Ciolino  4 , Faraz S Ahmad  3   5   6 , Tiffany Brown  1 , Dustin D French  7   8   9 , Randy Hountz  10 , Karen Iversen  11 , Stacy T Lindau  12   13 , Dawid Lipiszko  1 , Jennifer A Makelarski  13 , Kathryn Mazurek  14 , Linda Murakami  15 , Yaw Peprah  1 , Jennifer Potempa  16 , Luke V Rasmussen  6 , Andrew Wang  8 , Jesi Wang  17 , Chen Yeh  4 , Abel N Kho  1   3
Affiliations
Randomized Controlled Trial

Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care: A Practice-randomized, Comparative Effectiveness Trial

Stephen D Persell et al. Med Care. 2020 Apr.

Abstract

Background: Effective quality improvement (QI) strategies are needed for small practices.

Objective: The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care.

Design: Two arm, practice-randomized, comparative effectiveness study.

Participants: Small and mid-sized primary care practices.

Interventions: Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies.

Measures: Proportion of eligible patients in a practice meeting "ABCS" measures: (Aspirin) Aspirin/antiplatelet therapy for ischemic vascular disease, (Blood pressure) Controlling High Blood Pressure, (Cholesterol) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease, and (Smoking) Tobacco Use: Screening and Cessation Intervention, and the Change Process Capability Questionnaire. Measurements were performed at baseline, 12, and 18 months.

Results: A total of 226 practices were randomized, 179 contributed follow-up data. The mean proportion of patients meeting each performance measure was greater at 12 months compared with baseline: Aspirin 0.04 (95% confidence interval: 0.02-0.06), Blood pressure 0.04 (0.02-0.06), Cholesterol 0.05 (0.03-0.07), Smoking 0.05 (0.02-0.07); P<0.001 for each. Improvements were sustained at 18 months. At 12 months, baseline-adjusted difference-in-differences in proportions for the POC+PM arm versus POC was: Aspirin 0.02 (-0.02 to 0.05), Blood pressure -0.01 (-0.04 to 0.03), Cholesterol 0.03 (0.00-0.07), and Smoking 0.02 (-0.02 to 0.06); P>0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09-0.51) but did not significantly differ across arms.

Conclusion: Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.

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