Context: To compare rural independent and health system primary care practices with urban practices to external practice facilitation support in terms of recruitment, readiness, engagement, retention, and change in quality improvement (QI) capacity and quality metric performance. Methods: The setting consisted of 135 small or medium-sized primary care practices participating in the Healthy Hearts Northwest quality improvement initiative. The practices were stratified by geography, rural or urban, and by ownership (independent [physician-owned] or system-owned [health/hospital system]). The quality improvement capacity assessment (QICA) survey tool was used to measure QI at baseline and after 12 months of practice facilitation. Changes in 3 clinical quality measures (CQMs)—appropriate aspirin use, blood pressure (BP) control, and tobacco use screening and cessation—were measured at baseline in 2015 and follow-up in 2017. Results: Rural practices were more likely to enroll in the study, with 1 out of 3.5 rural recruited practices enrolled, compared with 1 out of 7 urban practices enrolled. Rural independent practices had the lowest QI capacity at baseline, making the largest gain in establishing a regular QI process involving cross-functional teams. Rural independent practices made the greatest improvement in meeting the BP control CQM, from 55.5% to 66.1% ( P ≤ .001) and the smoking cessation metric, from 72.3% to 86.7% ( P ≤ .001). Conclusions: Investing practice facilitation and sustained QI strategies in rural independent practices, where the need is high and resources are low, will yield benefits that outweigh centrally prescribed models.

中文翻译：

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地方问题：缩小农村初级保健质量改进能力的差距——健康心脏西北研究

背景：将农村独立和卫生系统初级保健实践与城市实践与外部实践促进支持在招聘、准备、参与、保留和质量改进 (QI) 能力和质量指标绩效的变化方面进行比较。方法：该环境由 135 家参与健康心脏西北质量改进计划的中小型初级保健机构组成。这些实践按地理、农村或城市以及所有权（独立[医师所有]或系统所有[卫生/医院系统]）进行分层。质量改进能力评估 (QICA) 调查工具用于在基线和 12 个月的实践促进后测量 QI。3 项临床质量测量 (CQM) 的变化——适当的阿司匹林使用、血压 (BP) 控制、和烟草使用筛查和戒烟——在 2015 年的基线和 2017 年的随访中进行了测量。结果：农村实践更有可能参加研究，3.5 个农村招募实践中有 1 个参加，而城市 7 个实践中有 1 个参加实践注册。农村独立实践在基线时的 QI 能力最低，在建立涉及跨职能团队的常规 QI 流程方面获得的收益最大。农村独立实践在满足血压控制 CQM 方面取得了最大的进步，从 55.5% 提高到 66.1% (P ≤ .001)，戒烟指标从 72.3% 提高到 86.7% (P ≤ .001)。结论：在需求高而资源低的农村独立实践中投资实践促进和持续 QI 策略将产生超过中央规定模式的收益。