Abstract
Background: More than 100 million individuals in the USA have been diagnosed with a chronic disease, yet chronic disease care has remained fragmented and of inconsistent quality. Improving chronic disease management has been challenging for primary care and internal medicine practitioners. Practice facilitation provides a comprehensive approach to chronic disease care. The objective is to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting. Methods: This systematic review examined North American studies from PubMed, EMBASE, and Web of Science (database inception to August 2017). Investigators independently extracted and assessed the quality of the data on chronic disease process and clinical outcome measures. Studies implemented practice facilitation and reported quantifiable care processes and patient outcomes for chronic disease. Each study and their evidence were assessed for risk of bias and quality according to the Cochrane Collaboration and the Grade Collaboration tool. Results: This systematic review included 25 studies: 12 randomized control trials and 13 prospective cohort studies. Across all studies, practices and their clinicians were aware of the implementation of practice facilitation. Improvements were observed in most studies for chronic diseases including asthma, cancer (breast, cervical, and colorectal), cardiovascular disease (cerebrovascular disease, coronary artery disease, dyslipidemia, hypertension, myocardial infarction, and peripheral vascular disease), and type 2 diabetes. Mixed results were observed for chronic kidney disease and chronic illness care. Discussion: Overall, the results suggest that practice facilitation may improve chronic disease care measures. Across all studies, practices were aware of practice facilitation. These findings lend support for the potential expansion of practice facilitation in primary care. Future work will need to investigate potential opportunities for practice facilitation to improve chronic disease outcomes in other health care settings (e.g., specialty and multi-specialty practices) with standardized measures.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1968-1977 |
| Number of pages | 10 |
| Journal | Journal of general internal medicine |
| Volume | 33 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2018 |
Funding
Funding Information This research was supported in part by the Agency for Healthcare Research (AHRQ) and Quality’s National Research Service Award Institutional Research T32 Training Grant HS000078/HS000084 (PI: Jane L Holl, MD, MPH), contract no. HHSA290201200019I and grant no. R18 HS023921. Additional support was provided by the Center for Healthcare Studies and the Center for Health Information Partnerships at the Institute for Public Health and Medicine, Northwestern University. The contents of this product are solely the responsibility of the authors and do not necessarily represent the official views of or imply endorsement by AHRQ or the U.S. Department of Health and Human Services. The authors thank Corinne Miller and Jonna Peterson at the Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, for their assistance in the development and the search of the literature. The authors would also like to thank Adela Mizrachi at the Institute for Public Health and Medicine, Northwestern University, for her editorial support. This paper has been previously presented at the 23rd Annual AHRQ NRSA Trainee Research Conference in June 2017. The authors declare that they do not have a conflict of interest.
Keywords
- chronic disease
- practice facilitation
- primary care
- quality improvement
- systematic review
ASJC Scopus subject areas
- Internal Medicine
