Engaging Primary Care Practices in Quality Improvement

In an effort to create a high-quality health care system in the United States, many payers, providers, delivery systems, and other organizations are supporting the use of quality improvement (QI) initiatives to improve the performance of primary care practices. QI requires that practices continually assess performance, plan changes in areas where improvements are warranted, monitor the effects of those changes, and refine as needed. Engaging primary care practices in these activities is an important component of efforts to improve population health, enhance patient and provider experiences, and reduce the cost of care. However, these activities are not routinely integrated into primary care, and engaging in QI activities will be a new endeavor for most practices.

External support organizations can offer assistance to build and sustain QI capacity in a meaningful and systematic way, but may benefit from strategies to help them engage with the primary care practices. Examples of external organizations that support practices in undertaking QI activities include organizations that provide practice facilitation (or coaching) services, such as QI organizations, regional extension centers, Area Health Education Centers, and professional societies and payers; and other health care organizations that own or contract with practices, such as accountable care organizations, integrated delivery systems, patient advocacy organizations, and medical groups. The individuals who support practices have a variety of titles, including practice facilitators, coaches, QI consultants, and extension agents. In this paper, we refer to these external change agents as practice facilitators.

This paper is written for practice facilitators and the organizations that train and deploy them for the challenging task of encouraging primary care practices to undertake QI activities. Although generally payers do not reimburse practices directly for QI work, some reward or penalize practices as part of either pilots or ongoing programs. Such programs typically are based on the quality and cost of care, which may involve publishing quality metrics or providing enhanced reimbursements to practices that offer more comprehensive or coordinated care. These programs often require practices to become recognized as patient-centered medical homes (PCMHs).