KPWHRI合作者博士. L.J. Fagnan 分享s an effective way to support rural practices, illustrating why “位置很重要.”

由L.J. Fagnan, MD, founding director of the 俄勒冈州 Rural Practice-based lol竞猜app Network

卫生公平有许多方面. 我的经验是在农村实践, 它们在地理上是孤立的, 五分之一的美国人生活在资源匮乏的地区. People who live in rural areas are more likely to report poor access to primary care and experience a lower quality of care, 即使他们有更高的肥胖率, 高血压, 和烟草的使用情况.

我一生中大部分时间都在农村生活和工作. 我的组织, 俄勒冈农村实践lol竞猜app网络(ORPRN), seeks to reduce rural health disparities by lol竞猜apping and improving the quality of community-based primary care. 克里斯汀狄龙, a rural family physician and former ORPRN chair summarized why building quality improvement (QI) capacity is an ORPRN priority. “Our communities depend on us for a huge portion of their health care,” she said. “很多俄勒冈农村居民需要照顾, and we can’t serve them if we keep doing things in the same way.”

Cardiovascular health is a major issue for rural practices. One of ORPRN's most important recent collaborations was with lol竞猜app推荐健康lol竞猜app所 (KPWHRI) on Healthy Hearts Northwest (H2N). This project, funded by the Agency for Healthcare Quality and lol竞猜app and co-led by me and 迈克尔Parchman 在KPWHRI, is focused on building QI capacity into primary care practices so they can better help their patients reduce their cardiovascular disease risk with support from a practice facilitator.

实践协调人展示了地点的重要性

ORPRN has found practice facilitation can be an effective way to help primary care practices improve care quality. 在这种方法中, trained facilitators build relationships with rural practices through in-person and virtual visits. 他们支持一个QI项目的所有方面, 从计划到测量对病人健康的影响, 专注于对每个实践有效的方法.

我们最近出版的 lol竞猜app using data from H2N — which includes more than 200 practices in Washington, 俄勒冈州, and Idaho — looked at how practices responded to the support offered by a practice facilitator by location (rural or urban) and ownership (health care organization or independent individual or small group). 我们发现, independently owned practices were most likely to accept our offer of support from a practice facilitator. 这些做法不仅更愿意报名, but their level of engagement was also higher than other primary care clinics working with facilitators. 除了, improvements in blood pressure control and support for smoking cessation were significantly greater for rural independent practices than other primary care clinics. 换句话说, 位置很重要.

Why does practice facilitation benefit independent rural primary care?

Practice facilitators may be particularly suited for independent rural practices because they:

• 提供“在肘部”的支持. 正如农村实践小组的一名成员所说, “I’m finding through projects like these that I learn best by doing, 与现场指导.”
• Support 作为团队运动的质量改进. 和我们一起工作的一个农村诊所的人说, "每一个走进来的成年人, we as a team need to be thinking about the [quality improvement] measures. … It is not the driver that ultimately wins the race, it’s the pit crew.一位医生说, “一个QI团队的努力是值得的, 虽然训练需要时间, 实现, 维护, 并刷新, 它可以为日常工作增添意义.” 
• Build on relationships and trust, which are highly valued in rural communities. 作为一个结果, H2N facilitators were viewed as practice allies who understood that the context of the practice was critical to change. One H2N facilitator noted that improvement cycles at the practices moved at the speed of trust.
• 通过交叉授粉克服农村隔绝. Practice facilitators were bridge builders, sharing best practices from one rural site to another. 
• Provide accountability, overcoming the isolation of rural practices. Contact with the practice facilitator held clinics accountable for making their planned changes.
• 作为啦啦队. Rural practices can easily overlook or dismiss small gains or changes they make in the midst of overwhelming patient needs and competing demands. Practice facilitators provide much-needed external validation of progress and help rural practices celebrate small successes and 维护 momentum to improve.

全国都在谈论基础设施, I propose that we consider practice facilitators as essential infrastructure for rural primary health care. They are as critical to supporting rural communities as broadband internet access.

A mechanism for funding practice facilitators is in the Affordable Care Act, 在初级保健推广计划中. Advancing this program would fund practice facilitators as welcome, effective allies for rural practices in building QI capacity and creating competencies essential to addressing rural health inequities and the survival of primary care practices in the communities they serve.