Primary Care Practice Facilitation Curriculum

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
540 Gaither Road
Rockville, MD 20850
www.ahrq.gov

Contract No. HHSA2902009000191-Task Order No.6

Prepared by:
Mathematica Policy Research
Princeton, NJ
Project Director: Deborah Peikes
Deputy Project Director: Dana Petersen
Principal Investigators: Deborah Peikes, Erin Fries Taylor, and Jesse Crosson

AHRQ Publication No. 15-0060-EF
September 2015

Preface

“The Agency for Healthcare Research and Quality recognizes that revitalizing the Nation’s primary care system is foundational to achieving high-quality, accessible, efficient health care for all Americans. The primary care medical home, also referred to as the patient centered medical home (PCMH), advanced primary care, and the healthcare home, is a promising model for transforming the organization and delivery of primary care.” These words, found in the welcome message on AHRQ’s PCMH Resource Center Web site, have served as the guiding principle for the development of this curriculum and other resources to help support the transformation of primary care practice from older models of care delivery to 21st Century models that provide better care, smarter spending, and healthier people.

Practice facilitation is one evidence-based approach to assisting practices with making the substantive, meaningful, and ongoing changes need to adopt these new models. Practice facilitation can also support other proven quality improvement techniques including data feedback and benchmarking, expert consultation and shared learning or learning collaboratives. The trusted relationships of practice facilitators with practice leaders, clinicians, and staff empowers practices to improve delivery of evidence-based care, increase patient engagement, and decrease the burnout rate of primary care health professionals.

This expanded Primary Care Practice Facilitation Curriculum is AHRQ’s latest and most extensive effort to support the education and training of practice facilitators. David Meyers, M.D., AHRQ’s Chief Medical Officer and former Director of the Center for Primary Care, Prevention and Clinical Partnerships envisioned the curriculum as the way to endow practice facilitators with the skills necessary to advance quality improvement in primary care. The Curriculum builds on two previous AHRQ products, Integrating Chronic Care and Business Strategies in the Safety Net: A Practice Coaching Manual and the Practice Facilitation Handbook: Training Modules for New Facilitators and Their Trainers.

We are grateful to AHRQ’s Cindy Brach, who was pivotal to both of these seminal products, for her continuing guidance on the Curriculum as well.  The Curriculum is also designed to complement AHRQ’s Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide-- an effort led by much of the same team that led the development of this curriculum. In addition, the Curriculum dovetails nicely with other AHRQ initiatives focused on quality improvement at the practice level, such as AHRQ’s TeamSTEPPS, HIT tools and resources, and Practice-based Research Networks.

Development of this curriculum was a Herculean, 2-year effort with many contributors, but special thanks go to the members of the Technical Expert Panel who gave so very generously of their time to conference calls and numerous requests for reviews of the content. (For panelist names, see the box at the end of this preface.) Deepest gratitude goes to Jay Crosson, Ph.D., from Mathematica Policy Research (MPR) and Lyndee Knox, Ph.D., from LA Net Community Health Resource Network. Without their leadership and writing expertise this project never would have come to fruition. Thanks also to the many contributing authors and the teams at Mathematica and LA Net who supported the work, especially Alex Bohn at MPR who effectively and cheerfully coordinated dozens of moving parts. Finally, thanks to the team at AHRQ who helped make this vision become a reality, especially the editorial team of Margi Grady, Kathy McKay, and Doreen Bonnett.

Our hope is that this curriculum will be taken up in whole or parts and used to prepare the next generations of practice facilitators to assist the physicians, nurse practitioners, physician assistants, nurses, medical assistants and office staff with their efforts to transform the way primary care is delivered. We also believe that portions of this curriculum can be helpful in health professions education programs to build competencies in practice-based learning and improvement, systems-based practice and other competency domains where knowledge and skills of quality improvement methods are needed. Only through working together can we be successful at truly revitalizing primary care, and thereby improving the health of the Nation.

Introduction

  • Download the Introduction (PDF Version- 345KB )

    Primary Author: Jesse Crosson, PhD, Mathematica Policy Research
    Contributing Authors: Lyndee Knox, PhD, LA Net Community Health Resource Network; Robert J. McNellis, MPH, PA, Agency for Healthcare Research and Quality

The Primary Care Practice Facilitation (PCPF) Curriculum is designed to support the development of a PCPF workforce prepared to help transform and revitalize primary care by supporting widespread adoption of new models of care delivery and the use of continuous quality improvement to improve health care outcomes. This PCPF curriculum can serve to train both new and experienced practice facilitators in the knowledge and skills needed to support meaningful improvement in primary care practices.

This curriculum builds on and expands earlier training resources for PCPF developed by the Agency for Healthcare Research and Quality (AHRQ). Some of the curriculum modules are new, and others are updated versions of material available in the Practice Facilitation Handbook. The objective of this curriculum is to provide a more comprehensive practice facilitator training curriculum. In conjunction with other practice facilitation training resources available from AHRQ (see text box below), this curriculum can be used to develop a comprehensive PCPF training program.

Other Practice Facilitator Training Resources from AHRQ

The Practice Facilitation Handbook: Training Modules for New Facilitators and Their Trainers
This handbook is the previous version of the training materials provided here.
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/index.html

Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide
This resource includes information on hiring, training, and supervising practice facilitators. The guide has information on the background and basic skills that practice facilitators should have prior to training.
Download PDF Version

Integrating Chronic Care and Business Strategies in the Safety Net
This is a step-by-step guide to for primary care teams working on quality improvement focused on implementing the chronic care model.
http://www.ahrq.gov/professionals/systems/primary-care/businessstrategies/index.html

This PCPF curriculum consists of 32 training modules. As described below, Module 1 provides information for instructors on adult education methods. Modules 2 through 32 focus on specific competencies and skills. Each module begins with an Instructor’s Guide, which identifies the PCPF competencies addressed in the module, the time that learners will need for preparation (including reading background material) and for the instructional session, the objectives of the module, and suggested instructional approaches. Each module contains instructional text on the topic written for both the instructor and learners.

The PCPF curriculum is organized into five parts:

  • Part 1: Use of Adult Education Methods in Teaching PCPF Core Competencies, Module 1. Focuses on adult education methods and is intended for use by instructors. It offers an overview of recommended training approaches and describes how each subsequent module contributes to the development of competencies that practice facilitators need for supporting primary care practice improvement.

  • Part 2: Introduction to Practice Facilitation, Modules 2 through 7. Provides a basic introduction to practice facilitation and work with primary care practices and includes an overview of a typical facilitation process. This part of the curriculum also introduces the importance of professionalism in the practice facilitation process.

  • Part 3: Core Competencies for Practice Facilitators, Modules 8 through 16. Presents core competencies for practice facilitators. This part aims to build expertise that is valuable for facilitators regardless of the specific improvement topic. Core competencies include quality improvement techniques and measurement skills.

  • Part 4: In the Practice, Modules 17 through 23. Provides training in common tasks a facilitator may undertake in practice settings, such as assessing readiness for change, preparing a practice to work with a facilitator, holding kickoff meetings, working with and supporting practice leaders, and running effective meetings.

  • Part 5: Implementing the Care Model and Patient-Centered Medical Home, Modules 24 through 32. Includes information for facilitators working with practices that are implementing the Care Model or are transforming into patient-centered medical homes (PCMHs). Both the Care Model and the PCMH promote changing delivery systems to encourage responsiveness to patients’ needs and preferences.

How to Use This Curriculum

This curriculum is designed to be used by an instructor as a resource when preparing new and experienced facilitators to work with primary care practices. Practice facilitators may also use the curriculum independently for self-study by omitting the instructor’s guide at the beginning of each module. As with any curriculum intended for use with adult learners, the use and sequence of the modules should be tailored to learners’ needs. Not all facilitators may benefit from all modules and, in general, the modules do not need to be completed sequentially. In those cases where modules build explicitly on learning from other modules, the instructor’s guides clearly indicate the proper sequencing of learning. For example, Module 30 on “Building Teams in Primary Care” builds directly on the more specific case of “Implementing Care Teams” discussed in Module 29. Additionally, Modules 13-to-15 cover the full spectrum of skills that facilitators need for helping practices use data in their improvement and transformation efforts and, in most cases, should be completed sequentially.

Follow principles of adult education. The instructional exercises provided in the instructor’s guide of each module follow the principles of adult education: Individuals learn best when the educational process is interactive, and when the existing expertise and experience of the learner is recognized and used as a resource in the educational process. Instructors are encouraged to incorporate the exercises suggested in each module into their teaching as well as others they may have used in the past. Whenever possible, instructors are also encouraged to invite experienced practice facilitators to co-teach specific modules and to discuss their “real world” experiences from working with practices. Learners will need get into the field and use their new skills as they help practices transform, and then reflect on their experiences as part of their ongoing professional development.

Tailor instruction to the needs of each learner. Instructors should tailor the sessions to meet the needs of the learners as well as the facilitation program that is sponsoring the training. The modules may be delivered as an intensive workshop of multiple hours or days, or in a series, such as weekly forums. The materials are designed primarily for onsite delivery to a group of learners but can be adapted for delivery through virtual conferencing. To deliver the curriculum virtually, the instructor will need to modify the interactive elements of each module to fit the virtual environment.

Encourage group activities. Working with a group of learners allows for interactive learning methods such as group discussions and role plays. However, the modules can be adapted for individualized self-study. In these cases, the learners may choose modules tailored to their specific needs. Interactive sections that require group participation can be eliminated or modified. For example, the learners could record responses to discussion questions in a journal.

Develop additional materials to support instruction. While the curriculum is intended to be comprehensive in its content and provide a solid introduction to the basics of facilitation, instructors will need to develop additional materials to complement those provided here. For example, the content of each module can be used to create presentations to support lectures and group activities.

Primary Care Practice Facilitation as an Emerging Profession

The PCPF workforce is an emerging profession with a developing body of knowledge and set of standards. The Agency for Healthcare Research and Quality has played an important role in supporting the development of this emerging workforce by:

  • commissioning training materials, PCPF program handbooks, a national PCPF listserv and periodic e-newsletter,
  • consensus reporting by experts, and
  • research on the effectiveness of different facilitation approaches.

This curriculum for PCPF training builds on and expands this prior work.

Part 1: Use of Adult Education Methods in Teaching PCPF Core Competencies

  • Module 1: Instructor’s Guide to Using the PCPF Curriculum (PDF Version- 452KB )

    Primary Author: Jesse Crosson, PhD, Mathematica Policy Research
    Contributing Authors: Lyndee Knox, PhD, LA Net Community Health Resource Network; Robert J. McNellis, MPH, PA, Agency for Healthcare Research and Quality

Part 2: Introduction to Practice Facilitation

  • Module 2: Practice Facilitation as a Resource for Practice Improvement (PDF Version- 861KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality
    Persons having difficulties accessing the above PDF file may request assistance through AHRQ’s mailbox at https://info.ahrq.gov. Let us know the nature of your accessibility problem, the Web address of the requested information, and your contact information.

  • Module 3: The Primary Care Landscape (PDF Version- 483KB )

    Primary Authors: Tricia Collins Higgins, Ph.D., Mathematica Policy Research; Elizabeth Babalola, M.P.H., Mathematica Policy Research; Jesse Crosson, Ph.D., Mathematica Policy Research; Erin Fries Taylor, PhD, MPP, Mathematica Policy Research; Deborah Peikes, PhD, MPA, Mathematica Policy Research

  • Module 4: An Introduction to Practice Organization and Management (PDF Version- 449KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Michael L. Parchman, M.D., M.P.H., MacColl Center for Health Care Innovation, Group Health Research Institute; Yeryca Ramos, B.S., Family Health Care Centers of Greater Los Angeles; John Kotick, J.D., LA Net Community Health Resource Network; Martin Serota, M.D., AltaMed Health Services

  • Module 5: Special Considerations When Working With Safety Net Practices (PDF Version- 817KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality; Melinda Davis, Ph.D., C.C.R.P., Department of Family Medicine at Oregon Health and Science University

  • Module 6: An Overview of the Facilitation Process (PDF Version- 2.5MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 7: Professionalism for Practice Facilitators (PDF Version- 1MB )

    Primary Author: Vanessa Nguyen, M.P.H., LA Net Community Health Resource Network
    Contributing Authors: Lyndee Knox, Ph.D., LA Net Community Health Resource Network; Melinda Davis, M.P.H., LA Net Community Health Resource Network

Part 3: Core Competencies for Practice Facilitators

  • Module 8: Approaches to Quality Improvement (PDF Version- 665KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 9: Using Appreciative Inquiry with Practices (PDF Version- 606KB )

    Primary Author: Lyndee Knox, PhD, LA Net Community Health Resource Network
    Contributing Authors: Caroline Carter, M.S., L.S.W., Starfish Practice, LLC; Beth Sommers, M.P.H., CPHQ, Oregon Rural Practice-based Research Network at Oregon Health & Science University; LeAnn Michaels, Oregon Rural Practice-based Research Network at Oregon Health & Science University

  • Module 10: Mapping and Redesigning Workflow (PDF Version- 8.7MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality
    Persons having difficulties accessing the above PDF file may request assistance through AHRQ’s mailbox at https://info.ahrq.gov. Let us know the nature of your accessibility problem, the Web address of the requested information, and your contact information.

  • Module 11: Using Root Cause Analysis to Help Practices Understand and Improve Their Performance and Outcomes (PDF Version- 751KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network; June Levine, M.S.N., B.S.N., R.N., LA Net Community Health Resource Network
    Contributing Authors: Beth Sommers, M.P.H., C.P.H.Q., Oregon Rural Practice-based Research Network at Oregon Health & Science University; LeAnn Michaels, Oregon Rural Practice-based Research Network at Oregon Health & Science University; Erin Fries Taylor, PhD, MPP, Mathematica Policy Research

  • Module 12: An Introduction to Assessing Practices: Issues to Consider (PDF Version- 795KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 13: Measuring and Benchmarking Clinical Performance (PDF Version- 905KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 14: Collecting Performance Data Using Chart Audits and Electronic Data Extraction (PDF Version- 1.8MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality; Melinda Davis, PhD, CCRP, Department of Family Medicine at Oregon Health and Science University

  • Module 15: Preparing and Presenting Performance Data (PDF Version- 1.5MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 16: Academic Detailing as a Quality Improvement Tool (PDF Version- 509KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality; Michael Fischer, MD, MS, Harvard Medical School and Brigham and Women’s Hospital

Part 4: In the Practice

  • Module 17: Introducing a Practice to Facilitation (PDF Version- 475KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 18: Assessing Practice Readiness for Change (PDF Version- 783KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 19: Conducting a Kickoff Meeting (PDF Version- 504KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 20: Creating Quality Improvement Teams and QI Plans (PDF Version- 1MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 21: Working With and Supporting Practice Leaders (PDF Version- 937KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Anthony Suchman, M.D., University of Rochester School of Medicine and Dentistry; Alan Adelman, M.D., Department of Family and Community Medicine at Penn State College of Medicine; Russell Kohl, M.D., TransforMED; Erin Fries Taylor, PhD, MPP, Mathematica Policy Research

  • Module 22: Running Effective Meetings and Creating Capacity for Practices to Run Effective Meetings (PDF Version- 1MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Jennifer Powell, M.P.H., MBA, Powell & Associates; Anthony Suchman, M.D., University of Rochester School of Medicine and Dentistry

  • Module 23: Documenting Your Work With Practices (PDF Version- 1.4MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

Part 5: Implementing the Care Model and Patient-Centered Medical Home

  • Module 24: Introduction to the Care Model (PDF Version- 637KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 25: The Patient-Centered Medical Home: Principles and Recognition Processes (PDF Version- 465KB )

    Primary Authors: Tricia Collins Higgins, Ph.D., Mathematica Policy Research; Lisa Schottenfeld, M.P.H., M.S.W., Mathematica Policy Research; Jesse Crosson, Ph.D., Mathematica Policy Research; Erin Fries Taylor, PhD, MPP, Mathematica Policy Research; Deborah Peikes, PhD, MPA, Mathematica Policy Research

  • Module 26: An Introduction to Electronic Health Records and Meaningful Use (PDF Version- 1.4MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality; Mary Mitchell, PMP, CPHIT, CPEHR, LA Care Health Plan; Erin Fries Taylor, PhD, MPP, Mathematica Policy Research

  • Module 27: Helping Practices Optimize EHRs for Patient-Centered Medical Home Transformation and Quality Improvement (PDF Version- 1.3MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Grace Floutsis, M.D., Community Health Alliance of Pasadena (ChapCare); Allyson Gottsman, Colorado Health Extension System
    Kari Loken, Colorado HealthTeamWorks; Mary McCaskill, North Carolina Area Health Education Center Program (NC AHEC) at University of North Carolina at Chapel Hill

  • Module 28: Using the AHRQ Care Model Toolkit with Practices (PDF Version- 415KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 29: Implementing Care Teams (PDF Version- 811KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 30: Building Teams in Primary Care (PDF Version- 592KB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Jesse Crosson, PhD, Mathematica Policy Research; Michael L. Parchman, MD, MPH, MacColl Center for Health Care Innovation, Group Health Research Institute; Carolyn Shepherd, MD, Leibig-Shepherd LLC

  • Module 31: Facilitating Panel Management (PDF Version- 1MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Author: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality

  • Module 32: Improving Self-Management Support and Engaging Patients in Care and Practice Improvement Topics (PDF Version- 1MB )

    Primary Author: Lyndee Knox, Ph.D., LA Net Community Health Resource Network
    Contributing Authors: Cindy Brach, M.P.P., Agency for Healthcare Research & Quality; Judith Schaefer, MPH, MacColl Center for Health Care Innovation, Group Health Research Institute

Download Consolidated Documents

Download the complete curriculum in a single PDF (PDF Version - 28MB )

Download just the appendices (PDF Version - 15MB ) Note: Individual module PDFs contain the relevant appendices.

These documents are in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders.

The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Suggested Citation

Primary Care Practice Facilitation Curriculum. AHRQ Publication No. 15-0060-EF, Rockville, MD: Agency for Healthcare Research and Quality; September 2015. https://pcmh.ahrq.gov/page/primary-care-practice-facilitation-curriculum