Characteristics of the CPC initiative
|
Facilitators
|
Adequate resources for new capacities (both financial and time)
| ✓ | ✓ | ✓ | ✓ | ✓ |
Compatibility with care improvement objectives
| | | ✓ | | |
Barriers
| | | | | |
Insufficient resources for new capacities (tools, financial, time)
| | |
x
|
x
| |
Complex or unclear requirements
| | |
x
|
x
| |
External environment and context
|
Facilitators
|
Effective local electronic HIE
| | ✓ | ✓ | | ✓ |
HIT “meaningful use” incentives
| ✓ | | | | |
Regional history of patient-centered medical home programs
| ✓ | ✓ | ✓ | ✓ | ✓ |
Barriers
|
Lack of direct electronic access to health information from other care settings
| |
x
|
x
| |
x
|
Delays in access to patient survey results
| | | |
x
| |
Gaps in electronic information available through HIE
| |
x
|
x
| |
x
|
Complexity of needs in patient population
| | |
x
| | |
Internal context and setting of the practice
|
Facilitators
|
Prior experience with quality improvement efforts
| ✓ | ✓ | ✓ | ✓ | ✓ |
Organizational commitment to population health approaches to care
| | ✓ | ✓ | | |
Independent practices could make rapid change
| ✓ | ✓ | ✓ | ✓ | ✓ |
System-affiliated practices had support for management, HIT, quality improvement
| | ✓ | ✓ | | ✓ |
Integration of new work with existing work processes
| | | ✓ | | |
EHR technology integrated with disease registries and patient reminder systems
| | ✓ | ✓ | | |
Prior use of shared decision-making tools
| | ✓ | ✓ | | |
Existing staff trained in patient self-management approaches
| | | | ✓ | |
Barriers
|
Organizational commitment to traditional office visit-driven model of care
| |
x
|
x
| | |
Independent practices lacked support for management, HIT, and quality improvement
| | |
x
| | |
System-affiliated practices had limited local authority to make change
|
x
|
x
|
x
|
x
|
x
|
Lack of a practice-level quality improvement infrastructure
|
x
|
x
|
x
|
x
|
x
|
Lack of population management systems and sufficient care management staffing
| | |
x
| | |
Lack of knowledge of available shared decision-making tools
| |
x
| |
x
| |
Preventive health and chronic illness-related data entered into EHRs as unstructured data
| |
x
|
x
| | |
EHRs had to be modified to integrate new work
| | |
x
|
x
| |
Characteristics and attitudes of practice staff and clinicians
|
Facilitators
|
Shared staff and clinician commitment to population health approaches to care
| | ✓ | ✓ | | |
Barriers
|
Clinician skepticism regarding the value of CPC requirements
| | |
x
|
x
| |
Shared staff and clinician commitment to office visit-driven model of care
| |
x
| | | |
CPC implementation process within the practice
|
Facilitators
|
Use of established quality improvement processes
| ✓ | ✓ | ✓ | ✓ | ✓ |
Use of pilot testing before making practice-wide changes
| ✓ | ✓ | ✓ | ✓ | ✓ |
Tailored assistance from regional learning faculty
| | | | ✓ | |
Standardization of implementation processes across system-affiliated practices
| ✓ | ✓ | ✓ | ✓ | ✓ |
Dedicated CPC implementation meetings
| ✓ | ✓ | ✓ | ✓ | ✓ |
Barriers
|
Implementation limited to some (not all) clinicians or care teams, creating multiple workflows for the same processes
| |
x
|
x
|
x
|
x
|
Knowledge of CPC requirements unevenly shared across practice members
| |
x
|
x
|
x
|
x
|