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A few of the key lessons learned about Practice Facilitation from the EvidenceNOW: Advancing Heart Health Initiative are listed here.

Lesson: Practices working with more effective practice facilitators had 3.6% higher mean delivery of heart health services. Effective facilitators used a combination of strategies.

Infographic: 

• Strategies Used by Effective Practice Facilitators (PDF, 544 KB)

Lesson: Practice facilitation with population-based tools can effectively promote implementation of evidence-based guidelines to reduce cardiovascular risk among patients in small, rural practices.

Reference:

• Cykert S, Keyserling TC, Pignone M, et al. A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices. Health Services Research, 2020 October 13.  

Lesson: Practice facilitators can be deployed to integrate community health workers (CHWs) into their primary care teams to support the effective implementation of community–clinical linkage models.

Reference:

• Islam N, Rogers ES, Schoenthaler A, et al. A cross-cutting workforce solution for implementing community-clinical linkage models. Am J Public Health. 2020 July; 110(S2): S191-S193.  

Lesson: Facilitators require multidisciplinary skills to support sustainable practice improvement in different healthcare delivery settings.

Reference:

• Nguyen AM, Cuthel A., Padgett DK, et al. How practice facilitation strategies differ by practice context. J Gen Intern Med 35, 824–831 (2020).  

Lesson: Increasing the impact of practice facilitation programs that target multiple risk factors may require a longer, more intense intervention and greater attention to external policy and practice contextual factors that may hinder the facilitation process and practice improvement goals.

Reference:

• Shelley DR, Gepts T, Siman N, et al. Cardiovascular disease guideline adherence: An RCT using practice facilitation. Am J Prev Med 2020; Feb 14. Available at: 

Lesson: A large-scale facilitation workforce with supporting infrastructure, including initial training, and ongoing support and monitoring, is required to support large-scale practice improvement.

Reference:

• Sweeney SM, Hemler JR, Baron AN, et al. Dedicated workforce required to support large-scale practice improvement J Am Bd Fam Med 2020; 33 (2): 230-239. DOI:  

Lesson: Trained practice facilitators will continue to serve as a critical resource to assist small, rural primary care practices in adapting to the ever-changing health environment and continue to deliver quality care to their communities.

Reference:

• Chou AF, Homco JB, Nagykaldi Z, et al. Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma. BMC Health Serv Res. 2018 Jun 4;18(1):404. doi: 10.1186/s12913-018-3189-4; 

Lesson: Practice support is necessary to help practices, particularly those with EHR data challenges, build their capacity for conducting data-driven QI, which is required to participate in practice transformation and performance-based payment programs.

Reference:

• Hemler JR, Hall JD, Cholan RA, et al. Practice facilitator strategies for addressing electronic health record data challenges for quality improvement: EvidenceNOW. JABFM 2018;31(3):398-409. PubMed PMID: 29743223; 

Lesson: Providers perceived three central practice facilitation benefits: creating awareness of quality gaps; connecting practices to information, resources, and strategies to improve care; and optimizing the EHR for quality improvement goals. Some practices valued the benefit of teaching and others the hands-on support.

Reference:

• Rogers ES, Cuthel AM, Berry CA, et al. Clinician perspectives on the benefits of practice facilitation for small primary care practices. Ann Fam Med 2019; 17 (Suppl 1):S17-S23.  

Lesson: Practice facilitation, combined with shared learning opportunities and educational outreach, were performance goals compared to those receiving PF alone.

Reference:

• Parchman ML, Anderson ML, Dorr DA, et al. A randomized trial of external practice support to improve cardiovascular risk factors in primary care. Ann Fam Med 2019; 17 (Suppl 1):S40-S49.  

Lesson: Targeted practice facilitator-supported efforts may be easier to implement in primary care than larger, more extensive quality improvement projects.

Reference:

• McHugh M, Brown T, Liss DT, Walunas T, Persell S. (2018). Practice facilitators' and leaders' perspectives on a facilitated quality improvement program. Ann Fam Med 2018;16(Suppl 1):S65-S71. 

Additional references can be found on the EvidenceNOW publications page under the Practice Facilitation section.