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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Personal Doctor or Nurse.

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Strategy. Practice Coaches/Facilitators

Approach. Encourage practice facilitation for primary care to increase access to primary care providers for children.

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Overview. Practice facilitation efforts include comprehensive approaches to ensuring care timeliness, increasing practice efficiency and patient-centeredness, improving continuity of care, and improving preventive and chronic care.[1] Efforts are led by practice coaches or facilitators who work with clinic staff to redesign clinical practices and improve the quality of care delivered. Coaches organize quality improvement (QI) efforts, help staff understand and use data to drive QI,[2] use team-building exercises to improve communication, share best practices, and explain how other organizations have improved care. They also help motivate interest in change and help practices choose goals, adopt new work process, interactively solve process problems, and incorporate health information technology.[3]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Provider Experience of Care. This strategy improves healthcare professionals' perceptions, feelings, and satisfaction with the work environment and systems they use.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of primary care practices that engage practice coaches/facilitators to support transformation efforts focused on increasing access to personal doctors or nurses for children. (Measures adoption of practice facilitation intervention)
  • Number of practice coaches/facilitators trained in pediatric-specific access and continuity of care best practices, tools, and strategies. (Shows workforce capacity building for tailored facilitation)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of primary care practices that engage practice coaches/facilitators to support transformation efforts focused on increasing access to personal doctors or nurses for children. (Measures adoption of practice facilitation intervention)
  • Percent of practice coaches/facilitators trained in pediatric-specific access and continuity of care best practices, tools, and strategies. (Shows workforce capacity building for tailored facilitation)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of primary care practices that sustain personal doctor or nurse models for children after initial practice facilitation support ends. (Measures long-term adoption)
  • Number of policy and payment reforms that incentivize and support primary care practices in ensuring personal doctors or nurses for children. (Assesses enabling system changes)

OUTCOME MEASURES:

  • Number of primary care practices that demonstrate sustained improvements in pediatric access, preventive care, and care coordination with personal doctors or nurses. (Indicates practice-level performance impact)
  • Number of communities that achieve reduced pediatric emergency department visits and hospitalizations through increased access to personal primary care. (Measures population health impact)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of primary care practices that sustain personal doctor or nurse models for children after initial practice facilitation support ends. (Measures long-term adoption)
  • Percent of policy and payment reforms that incentivize and support primary care practices in ensuring personal doctors or nurses for children. (Assesses enabling system changes)

OUTCOME MEASURES:

  • Percent of primary care practices that demonstrate sustained improvements in pediatric access, preventive care, and care coordination with personal doctors or nurses. (Indicates practice-level performance impact)
  • Percent of communities that achieve reduced pediatric emergency department visits and hospitalizations through increased access to personal primary care. (Measures population health impact)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] CWF-Grumbach 2012 - Grumbach K. Facilitating improvement in primary care: The promise of practice coaching. New York: The Commonwealth Fund (CWF); 2012: Issue Brief.

2 Taylor 2013a - Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN. Enhancing the primary care team to provide redesigned care: The roles of practice facilitators and care managers. Annals of Family Medicine. 2013;11(1), 80-;83.

3 AHRQ-Coleman 2009 - Coleman K, Pearson M, Wu S. Integrating chronic care and business strategies in the safety net: A practice coaching manual. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2009.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.