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Introduction/Objectives: Comprehensive eye exams are recommended at least every 2 years for people with diabetes for early identification and treatment of diabetic eye disease, but screening rates remain suboptimal. Our objective was to qualitatively assess barriers and facilitators to completing recommended eye exam screening for patients with diabetes among providers and practice staff. Methods: As part of a larger initiative, we conducted discussion groups with healthcare providers and practice staff to evaluate factors related to referral and screening for diabetic eye disease at 2 sites, a safety-net healthcare system and a specialty clinic. Discussions were audio-recorded and transcribed. Combined inductive, deductive thematic content analysis was conducted, applying the Practical Robust Implementation and Sustainability Model to organize themes and subthemes. Results: Two discussion groups with 28 participants were conducted in August 2023. Themes included existing processes for referrals, scheduling, and tracking; patient-level determinants including transportation and financial barriers and other competing demands to receiving recommended eye screening; clinic or system-related factors, and considerations for process improvement for eye exam referrals and appointments. Conclusions: These findings can be applied to determine the most effective strategies to improve the rates of recommended eye exam referral and screening rates in people with diabetes. [ABSTRACT FROM AUTHOR]

Background: Practice facilitators (PFs) provide tailored support to primary care practices to improve the quality of care delivery. Often used by PFs, the "Key Driver Implementation Scale" (KDIS) measures the degree to which a practice implements quality improvement activities from the Chronic Care Model, but the scale's psychometric properties have not been investigated. We examined construct validity, reliability, floor and ceiling effects, and a longitudinal trend test of the KDIS items in the Southeastern Collaboration to Improve Blood Pressure Control trial. Methods: The KDIS items assess a practice's progress toward implementing: a clinical information system (using their own data to drive change); standardized care processes; optimized team care; patient self-management support; and leadership support. We assessed construct validity and estimated reliability with a multilevel confirmatory factor analysis (CFA). A trend test examined whether the KDIS items increased over time and estimated the expected number of months needed to move a practice to the highest response options. Results: PFs completed monthly KDIS ratings over 12 months for 32 primary care practices, yielding a total of 384 observations. Data was fitted to a unidimensional CFA model; however, parameter fit was modest and could be improved. Reliability was 0.70. Practices started scoring at the highest levels beginning in month 5, indicating low variability. The KDIS items did show an upward trend over 12 months (all p <.001), indicating that practices were increasingly implementing key activities. The expected time to move a practice to the highest response category was 9.1 months for standardized care processes, 10.2 for clinical information system, 12.6 for self-management support, 13.1 for leadership, and 14.3 months for optimized team care. Conclusions: The KDIS items showed acceptable reliability, but work is needed in larger sample sizes to determine if two or more groups of implementation activities are being measured rather than one. [ABSTRACT FROM AUTHOR]

Background: Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state and a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD outcomes and risk factors by race or ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes academic and community stakeholders, was formed to support primary care practices to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use screening., Objective: The study aimed to support primary care practices to increase BP control among adults with hypertension and increase rates of tobacco use screening and cessation intervention., Methods: We are using a type 1 hybrid design to test the effects of the HHIP on BP control among adults with hypertension and tobacco use screening and cessation intervention, while collecting information on implementation. Primary care practices were recruited through existing practice networks and additional electronic and in-person outreach. To ensure participation from a broad range of clinics, we required at least 50% of practices to be Federally Qualified Health Centers or look-alikes and to include representation from practices in rural areas. At baseline, we collected information about practice characteristics and preintervention rates of BP control and tobacco use screening and cessation intervention. The QI intervention includes quarterly activities conducted over a 12-month period. The HHIP uses a multipronged approach to QI, including practice facilitation and technical assistance, on-site and e-learning, and improvement through data transparency. We will conduct a pre-post analysis to estimate the effects of the HHIP and whether there is an enduring change in outcomes after the 12 months of HHIP activities beyond what would be expected due to secular trends., Results: Practice recruitment took place between April 2021 and October 2022. After contacting 417 primary care practices, 51 were enrolled, including 28 Federally Qualified Health Centers or look-alikes; 47 practices implemented the HHIP. Among 45 practices that completed the baseline survey, 11 (24%) were solo practices, while 28 (62%) had 1-5 clinicians, and 6 (13%) had 6 or more clinicians. The median number of patient visits per year was 5819 (IQR 3707.3-8630.5). Practices had been in operation for a mean of 19.2 (SD 13.0) years. At baseline, the mean BP control rate was 49.6% and the rate of tobacco use screening and cessation intervention was 67.4%., Conclusions: If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and, subsequently, cardiovascular health and health equity in the state of Alabama., International Registered Report Identifier (irrid): DERR1-10.2196/63685., (©Kathryn Foti, Demetria Hubbard, Kimberly A Smith, Larry Hearld, Joshua Richman, Trudi Horton, Sharon Parker, Dodey Roughton, Macie Craft, Stephen A Clarkson, Elizabeth A Jackson, Andrea L Cherrington. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 20.12.2024.)

Background: Practice facilitation (PF) is a promising but relatively new intervention supporting data-driven practice change. There is a need to better detail research-based facilitation methods, which must balance intervention fidelity and time restrictions with the flexibility required for the intervention. As part of a multi-level 4-armed cluster randomized clinical trial (RCT), 32 rural primary care practices received PF for 1 year. We evaluated the feasibility of having facilitators guide practices to perform 4 key driver domain activities, implemented as Plan-Do-Study-Act (PDSA) cycles, to better understand facilitation "exposure." We describe the intervention and activity length such that our experiences may be useful to other PF research efforts., Methods: Thirty-two practices serving rural patients involved in the Southeastern Collaboration to Improvement Blood Pressure Control engaged with a facilitator to develop and implement PDSAs nested within key drivers of change domains. Numbers of months practices worked on activities deemed most likely to be sustained were captured along with practice satisfaction data., Results: All practices engaged in at least 4 domain-level activities, and 59% of the PDSAs were active for at least 3 months. There was variation by domain in the average length of the PDSA activities. Ninety-seven percent (31 of 32) of practices recommended similarly structured facilitation services to other primary care practices, and 84% (27 of 32) noted substantive changes in their care processes., Conclusion: In this trial, it was feasible for PFs to engage practices in at least 4 Key Driver quality improvement activities within 1 year, which will inform PF methods and protocol development in future trials., Competing Interests: Conflict of interest: The authors have no conflicts of interest to disclose., (© Copyright 2021 by the American Board of Family Medicine.)