Each of the four IMPaCT grants developed a complex program structure as part of its efforts to build primary care QI infrastructure. All of the IMPaCT teams strengthened previous work with stakeholder partners and primary care practices. They also worked to engage new partners and practices and to coordinate with related efforts of other State or community entities. Partnerships emerged at both the State level and the county and regional level. Local tailoring of both the PCEP structure and activities was essential.
This synthesis report highlights two primary areas for future research. First, the relationship between external QI support and improved clinical outcomes merits further study. The Evidence Now initiative that AHRQ funded in 2015 will yield valuable findings to address this gap. Second, the complex interplay between incentives and competition that shape the formation of multistakeholder partnerships is important to understand. How do these drivers ultimately motivate practices to embark on and sustain QI efforts?
Key Questions for Sustainability and Expansion
Based on the findings noted throughout this summary, key questions that could be considered for sustainability and expansion of State-level programs to support PCEP efforts include:
- What is the long-term result of PCEP involvement on primary care practice QI capacity, as measured by clinical outcomes and practice organization?
- How do PCEP partnerships change over time and why?
- How can PCEP partnerships be most effectively supported at the multiple geographic scales that emerge, including regional and cross-State efforts?
- How can PCEPs leverage evolving incentives (e.g., meaningful use stage 3) to reinforce practices’ improvement and redesign efforts?
- How can primary care practices fund time for their clinicians and staff to stay engaged in effective PCEP-related opportunities, such as learning collaboratives?
- How do PCEPs support and benefit from workforce development of roles that support linkages across organizations and practices, including community health workers and practice facilitators?