PrPractice Facilitation in Primary Care: LA Net's Experience
AHRQ's 2012 Annual Conference Slide Presentation
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Slide 1
Practice Facilitation in Primary Care
LA Net's Experience
LA Net Community Health Resource Network
Slide 2
About LA Net
- Practice Based Research and Resource Network.
- Created in 2002 with funding from AHRQ and HRSA:
- 23 FQHCs [Federally Qualified Health Centers], CHCs [Community Health Centers], Free Clinics, Private Practices in safety net.
- 165 practice sites.
- 1.2 million patient visits per year.
- Patient Population:
- 69% Latino.
- 10% African American.
- 5% Asian American.
- Other.
Slide 3
LA Net
Image: A map of the greater Los Angeles area shows the locations of the LA Net partners.
LA Net organizational partners
Slide 4
What LA Net does
- Focused on improving health outcomes for low-income families in Los Angeles and Orange Counties.
- Three Activities:
- Practice-based and led research.
- Quality Improvement (QI) facilitation.
- Community empowerment.
- Services:
- Practice Facilitators (PF):
- Research support.
- Quality improvement facilitation/PCMH transformation.
- Best practice translation/dissemination.
- Specialty care support for safety net:
- Project ECHO Knowledge Networks.
- Community health worker/peer mentor programs:
- Maternal depression.
- Chronic disease.
- Practice Facilitators (PF):
Slide 5
LA Net's Practice Improvement Facilitation Program
- Workforce:
- 3 FTE staff facilitators.
- 6 consultant facilitators.
- 7 student/trainee facilitators from local university.
Images: Photographs of three workforce members are shown: Vanessa Nguyen, MPH; Zoe-Anne Fitzhugh, RN; and Diana Traje, MPH.
- Model:
- Permanent attachment to a practice.
- 1:10 active PF to practice ratio.
- 1:30 maintenance PF ratio.
- On-site support.
Slide 6
LA Net's Practice Improvement Facilitation Program
- Methods:
- Academic detailing.
- On-site PF support for training, data systems set-up, HIT optimization.
- Local Learning collaboratives.
- Virtual knowledge networks.
Slide 7
LA Net's Practice Improvement Facilitation Program
Core activities
- QI Infrastructure Creation:
- Team.
- Training.
- Dashboards.
- Population Health Infrastructure Creation:
- HIT optimization:
- Registries.
- EHRs.
- Care team and staff training.
- Workflow design.
- HIT optimization:
- Research.
Slide 8
LA Net's Practice Improvement Facilitation Program
Examples of projects
- NCQA Application for PCMH:
- Hands on support & project management.
- CKD Guideline Implementation:
- Data/dashboard on performance.
- QI infrastructure.
- Registry optimization.
- EHR optimization (templates, automatic ordering).
- Spread of exemplar practice.
- Diabetes Managed Care (DMC)Clinics:
- Region-wide spread of best practice in DMC management.
- Implementation support:
- Registry creation/optimization.
- EHR optimization.
- Role definition for expanded care team.
- Workflow redesign.
- QI/patient outcomes monitoring/tracking system.
Slide 9
LA Net's Practice Improvement Facilitation Program
Biggest Challenges in Establishing the Program
- Workforce.
- Building receptor site for facilitation in practices and funder communit.
- Sustained funding.
Biggest Successes
- Practices are self-paying for PF support now.
- Triple "threat"—services have grown to include:
- Facilitators.
- Virtual Knowledge Networks with Specialists/PCPs (Project ECHO).
- Relationships with research community for translation of best evidence.
Slide 10
How to Guide
How to Start and Run a Practice Facilitation Program
Image: The cover of Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide is shown.
Slide 11
How to Guide
Contents
Image: The Table of Contents page for Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide is shown.
Slide 12
How to Guide
Some of the Gems
- Importance of using a key-driver model to guide intervention design and work.
- Different supports/line items needed for PFs to function.
- Recommendations for training PFs:
- Tailored training.
- Content areas.
- Importance of elevating/reminding PFs about their role as "spread agents."
- Strategies for funding.
- Certificate of Maintenance, research partnerships.
- Idea of permanent connection to practice.
- Importance of peer-to-peer relationships.
- Importance of teaching practices on how to use a PF.
- Using the "Practice Registry" for monitoring progress while PFs are in the field.
Slide 13
Next Steps for Us
A version of the National Primary Care Extension Program
- Long-term permanent PF workforce in LA County.
- Every safety net practice with PF support.
- Every safety net practice hooked in to ECHO knowledge network.
- Cooperative resources in population management & self management support.
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