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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地点很重要：缩小农村初级保健质量改进能力的差距——健康之心西北研究


背景：将农村独立和卫生系统初级保健实践与城市实践进行比较，以在招募、准备、参与、保留以及质量改进 (QI) 能力和质量指标绩效的变化方面提供外部实践促进支持。方法：该机构由参与健康西北质量改进计划的 135 个中小型初级保健机构组成。这些实践按地理位置、农村或城市以及所有权（独立[医生所有]或系统所有[卫生/医院系统]）进行分层。使用质量改进能力评估 (QICA) 调查工具来测量基线和 12 个月练习促进后的 QI。在 2015 年基线和 2017 年随访中测量了 3 项临床质量指标 (CQM) 的变化——适当使用阿司匹林、血压 (BP) 控制以及烟草使用筛查和戒烟。 结果：农村实践更有可能参与在这项研究中，每 3.5 名农村招聘执业医师中就有 1 名注册，而城市招聘的执业医师中这一比例为七分之一。农村独立实践的 QI 能力基线最低，在建立涉及跨职能团队的定期 QI 流程方面取得了最大的收益。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)，在戒烟指标方面，从 72.3% 提高到 86.7% ( P ≤ .001)。结论：在需求高、资源低的农村独立实践中投资实践便利化和持续的 QI 策略，所产生的效益将超过集中规定的模型。