Assessing Quality Improvement Capacity in Primary Care Practices

Background Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. Field notes kept by the PFs from practices with high and low QICA scores were compared. Results The QICA score was associated with prior experience managing change and two of the three CQMs: aspirin use (r=0.16, p=0.049) and blood pressure control (r=0.18, p=0.013). Rural practices and those with 2-5 clinicians had lower QICA scores. PFs notes provide examples of high scoring practices devoting time and attention to quality improvement whereas low scoring practices did not. Conclusions The QICA is useful for both assessing QI capacity within a practice and for guiding PFs and practices in efforts to build this capacity. Further work is needed to understand how PFs and practices tailored their work in response to this practice-level assessment and how practices used it to improve their QI capacity.