We collected and reviewed publically available materials about the IMPaCT projects, as well as final grant reports and other materials supplied by the grantees. We also conducted a 1-hour interview with the principal investigator (PI) of each of the four grants between November 2014 and January 2015. Some PIs chose to invite additional members of their research teams to join the calls. Interview notes were recorded and transcribed. For two of the projects, the original PI had changed institutions at the time our review took place; in these cases, we spoke to both the original and new PI for the grant. The topics discussed during the calls included:
- The history of State-level QI efforts before the AHRQ grant.
- IMPaCT objectives and activities.
- Stakeholder interactions.
- Activities with partner States.
- Environmental context for the implementation.
- Evaluation approach.
- Results of implementation and spread efforts, including sustainability.
- Advice for others building multipractice or multi-State external QI support.
In addition, we conducted a 1-hour interview with a representative of one of the partner States who had worked with the AHRQ IMPaCT grant. During these calls, we asked about the partnership mechanism and how the partnership influenced extension planning in the partner State.
Based on our review of the information we collected, we compiled information about the elements of each program, analyzed common themes about best practices for scaling primary care QI efforts, and identified research gaps. Through this process we learned that enhancement efforts within model States differed markedly from spread efforts to partner States; thus, these two components are presented separately.
We organized our analysis based on theoretical insights of dissemination science, particularly Greenhalgh and colleagues’ model of diffusion and innovation in service organizations.5 This model characterizes diffusion as a process involving interactions between elements, including:
- The innovation (in this case, enhancement and dissemination program components).
- System structure (e.g., extension program structure consisting of primary care practices and State-level organizations).
- Linkage agents (e.g., practice coaches).
- External context (e.g., payment, legislation, and culture).
Throughout this report we will describe how each grant utilized the unique resources that were available to enable the diffusion of the PCEP model in both the model and partner States.