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Research ArticleOriginal Research

Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model

Katrina E. Donahue, Warren P. Newton, Ann Lefebvre and Marcus Plescia
The Annals of Family Medicine May 2013, 11 (3) 212-219; DOI: https://doi.org/10.1370/afm.1497
Katrina E. Donahue
1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
2Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
MD, MPH
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  • For correspondence: kdonahue@med.unc.edu
Warren P. Newton
1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
MD, MPH
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Ann Lefebvre
1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
3North Carolina Area Health Education Centers, Chapel Hill, North Carolina
MSW, CPHQ
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Marcus Plescia
4North Carolina Division of Public Health, Raleigh, North Carolina
MD, MPH
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  • Scaling up Practice Transformation
    William E. Hogg
    Published on: 09 July 2013
  • Published on: (9 July 2013)
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    Scaling up Practice Transformation
    • William E. Hogg, Family Physician

    I am struck by how far research in this area has come since the initial randomized controlled trials. At that early stage, our efforts to examine the processes of facilitation were to be able to report on the fidelity of the intervention delivered as compared to the study protocol. Donahue and colleagues in this paper are studying the processes of quality improvement in a way they describe as the natural history of practi...

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    I am struck by how far research in this area has come since the initial randomized controlled trials. At that early stage, our efforts to examine the processes of facilitation were to be able to report on the fidelity of the intervention delivered as compared to the study protocol. Donahue and colleagues in this paper are studying the processes of quality improvement in a way they describe as the natural history of practice transformation. Rather than a facilitation intervention research project they are studying a quality improvement program that is state wide.

    Donahue et al's work is precisely the kind of research that is needed now in this field. We do not need more randomly controlled trials to prove that it works. We need insight to how and in what circumstances it works as a program. Given the high cost of effective QI, one wonders if the practices that are "engaged" but not improving from the effort should wait and try again when they are better able to benefit. The resources could then be applied to activated and transforming practices.

    I was amused by the QI effort to discourage the geese from hanging around the parking lot of one of the practices. As a Canadian researcher I feel the need to speak up. If these were Canadian geese, the practice must invoke a very slow PDSA cycle and wait a full year before they conclude whether or not they have been successful. The geese will leave and fly north in the spring regardless of what the practices does!

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
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The Annals of Family Medicine: 11 (3)
The Annals of Family Medicine: 11 (3)
Vol. 11, Issue 3
May/June 2013
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Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model
Katrina E. Donahue, Warren P. Newton, Ann Lefebvre, Marcus Plescia
The Annals of Family Medicine May 2013, 11 (3) 212-219; DOI: 10.1370/afm.1497

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Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model
Katrina E. Donahue, Warren P. Newton, Ann Lefebvre, Marcus Plescia
The Annals of Family Medicine May 2013, 11 (3) 212-219; DOI: 10.1370/afm.1497
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  • Practice Facilitator Strategies for Addressing Electronic Health Record Data Challenges for Quality Improvement: EvidenceNOW
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  • Bringing Patients Into the Patient-Centered Medical Home: Lessons Learned in a Large Primary Care Practice
  • Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? No.
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