Article Figures & Data
Figures
- Figure 1
Flowchart of identification of relevant studies.
- Figure 2
Effect of practice facilitation vs control in random-effects meta-analysis sorted from low to high methodological performance and effect size (N = 23).
- Figure 3
Publication bias funnel plot with observed (N = 23) and imputed studies.
- Figure 4
Number of practices per facilitator and effect size (n = 21).
- Figure 5
Intensity of intervention and effect size (N = 23).
Tables
- Table 1
Research Design Characteristics of Studies with High Methodological Performance Scores (N = 23)
Author, Year Scorea Trial Characteristics Outcome Measure Months Follow-up (% Retention) Effect Size SMD (SE) 95% CI Kottke et al,63 1992 6 Design: CCT
Allocation concealed: N
Blindedb: Y
Intent to treat: YMean percentage of patients advised to quit 19 (83) 1.01 (0.52) 0.00 to 2.02c McBride et al,67 2000 6 Design: RCT
Allocation concealed: N
Blindedb: N
Intent to treat: NPercentage of records with CVD screening 18 (100) 0.82 (0.46) –0.08 to 1.72 Stange et al,48 2003 6 Design: RCT
Allocation concealed: N
Blindedb: N
Intent to treat: NMean rate of preventive service 24 (NR) 0.59 (0.23) 0.13- to 1.05c Lobo et al,57 2004 6 Design: RCT
Allocation concealed: Y
Blindedb: N
Intent to treat: NMean health-related quality of life 21 (57) 0.44 (0.18) 0.09 to 0.79c Roetzhiem et al,34 2005 6 Design: C-RCT
Allocation concealed: N
Blindedb: Y
Intent to treat: NMean number of CA-screening tests 24 (100) 0.84 (0.29) 0.27 to 1.41c Hogg et al,78 2008 6 Design: CCT
Allocation concealed: N
Blindedb: N
Intent to treat: YMean preventive performance index 6 (87) 0.73 (0.29) 0.16 to 1.30c Aspy et al,82 2008 6 Design: CCT
Allocation concealed: N
Blindedb: Y
Intent to treat: NPercent given physical inactivity brief intervention 18 (89) 1.12 (0.36) 0.42 to 1.82c Jaén et al,85 2010 6 Design: RCT
Allocation concealed: N
Blindedb: Y
Intent to treat: NMean prevention service score 26 (86) 0.04 (0.37) –0.69 to 0.77 Cockburn et al,70 1992 7 Design: RCT
Allocation concealed: N
Blindedb: N
Intent to treat: NMean number of cessation cards used 3 (79) 0.24 (0.15) –0.06 to 0.54 Modell et al,55 1998 7 Design: RCT
Allocation concealed: N
Blindedb: N
Intent to treat: NMedian number of hemoglobin tests 12 (100) 0.32 (0.40) –0.45 to 1.09 Engels et al,80 2006 7 Design: RCT
Allocation concealed: Y
Blindedb: N
Intent to treat: YMean number of projects initiated 12 (92) 1.04 (0.32) 0.41 to 1.67c Aspy et al,83 2008 7 Design: RCT
Allocation concealed: N
Blindedb: Y
Intent to treat: NMean percent with MMG 9 (100) 1.31 (0.57) 0.20 to 2.42c Deitrich et al,59 1992 18 Design: RCT
Allocation concealed: N
Blindedb: Y
Intent to treat: NMean rate of prevention service 12 (96) 0.59 (0.29) 0.02 to 1.16c Lobo et al,57 2002 8 Design: RCT
Allocation concealed: Y
Blindedb: N
Intent to treat: YMean number of adherence items 21 (100) 0.66 (0.19) 0.30 to 1.02c Bryce et al,47 1995 9 Design: RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: YPercentage of consults initiated for asthma 12 (93.3) 0.62 (0.31) 0.02 to 1.22c Kinsinger et al,56 1998 9 Design: RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: NPercentage of patients with CBE and MMG 18 (94) 0.47 (0.27) –0.05 to 0.99 Solberg et al,69 1998 9 Design: RCT
Allocation concealed: Y
Blindedb: N
Intent to treat: YMean number of preventive systems processes 22 (100) 1.08 (0.32) 0.45 to 1.71c Lemelin et al17 2001 9 Design: RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: NMean preventive performance index 18 (98) 0.98 (0.32) 0.36 to 1.60c Frijling et al,35 2002 9 Design: C-RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: YPercentage giving eye examination 21 (95) 0.26 (0.18) –0.09 to 0.61 Frijling et al,65 2003 9 Design: C-RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: YPercentage assessing hypertension risk 21 (95) 0.39 (0.18) 0.04 to 0.74c Margolis et al,58 2004 10 Design: RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: YMean percentage given preventive service 30 (100) 0.60 (0.31) 0.00 to 1.20c Mold et al,81 2008 10 Design: RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: YPercentage implementing processes 6 (100) 0.94 (0.53) –0.10 to 1.98 Hogg et al,79 2008 12 Design: RCT
Allocation concealed: Y
Blindedb: Y
Intent to treat: YMean preventive performance index 13 (100) 0.11 (0.27) –0.42 to 0.64 -
CA = cancer; CBE = clinical breast examination; CCT = controlled clinical trial; C-RCT = cluster randomized-controlled trial; CVD = cardiovascular disease; MMG = mammography; N = no (not reported); RCT = randomized controlled trial; SE = standard error; SMD = standardized mean difference; Y = yes (reported).
-
↵a Scored on a scale from 0 to 12, in which the higher the score, the higher the quality of the study methods.
-
↵b Single- or double-blind study.
-
↵c P <.05; z statistic.
-
Supplemental Tables
Supplemental Table 1. Excluded Studies With Low Methodological Performance Scores (n = 21); Supplemental Table 2. Intervention Characteristics of Studies With High Methodological Performance Scores (N = 23)
Files in this Data Supplement:
- Supplemental data: Table - PDF file, 3 pages, 135 KB
- Supplemental data: Table - PDF file, 3 pages, 127 KB
The Article in Brief
Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings
N. Bruce Baskerville , and colleagues
Background Practice facilitation is a multifaceted approach in which skilled individuals help others address the challenges in implementing evidence-based care guidelines in the primary care setting. As the United States attempts to redesign medical practice, practice facilitation increasingly is used to assist with needed practice changes. This study, a systematic review of the existing literature, examines the overall effect of practice facilitation.
What This Study Found Practice facilitation has a robust effect on the adoption of evidence-based guidelines in primary care. The systematic review, which includes 23 studies representing nearly 1,400 primary care practices, finds that practices are 2.76 times more likely to adopt evidence-based guidelines with practice facilitation than without. Tailoring the intensity of the intervention to the needs of the practice and the number of practices per facilitator has an impact on the effectiveness of the facilitation.
Implications
- The authors call for large-scale collaborative, practice-based evaluation research to understand the impact of facilitation on the adoption of guidelines, the relationship between context and the components of facilitation, sustainability, and costs to the health system.
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