Does practice coaching improve practice performance?
Evidence reveals improvement in the quality of primary care.
There is a growing body of evidence that supports the effectiveness of practice facilitation interventions, summarized in the 2013 AHRQ publication Developing and Running a Primary Care Practice Facilitation Program: A How-To Guide (see “Dig Deeper”).
A recent meta-analysis of studies of practice facilitation within primary care settings concluded that primary care practices are almost three times as likely to adopt evidence-based guidelines through practice facilitation compared with no-intervention control group practices (Baskerville, Hogg, and Liddy, 2011). The study found that, as the number of practices supported by a facilitator increased, the effect size of facilitation decreased, while the intensity of the intervention—the number and length of facilitation sessions—was associated with larger changes.
Two systematic literature reviews have been conducted on practice facilitation. In the first review, Nagykaldi and colleagues (2005) searched publications from 1966 to 2004 and found 25 studies that measured the effect of interventions involving practice facilitators on patient care outcomes in primary care. Of the eight with rigorous study designs, the authors found that, while there was evidence supporting the effectiveness of practice facilitators, facilitators often were one part of an intervention with many other components, making it difficult to distinguish effects due solely to facilitators. Nevertheless, Nagykaldi and colleagues concluded that practice facilitators increased the delivery rates of preventive services and also improved relationships and communication between providers, assisted clinicians with chronic disease management, provided professional education, and facilitated system-level improvements.
Baskerville (2009) found solid evidence for the effectiveness of practice facilitation as a means of improving quality of primary care services and concluded that these improvements were most likely to occur when multicomponent interventions are used, interventions focus on organizational and systemic aspects of a practice, and systems and tools used reflect the reality of a practice setting.
Compiled by Jen Powell, an AF4Q technical advisor working with the Improving Performance in Practice (IPIP) Technical Support Team.
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