Tools and Resources for Practice Transformation and Quality Improvement

These AHRQ tools were developed and tested by those on the front lines of practice transformation and quality improvement. They can be used to facilitate transformation in practices of any size from solo and small practices to large group practices and integrated networks.

Resources and tools in this section fall into nine categories

Implementing Primary Care Transformation

  • The Patient-Centered Medical Home Resource Center website features evidence, examples, and lessons learned from primary care practices that have transformed their approach to organizing and delivering care. Policymakers, researchers, practices, and practice facilitators can access evidence-based resources about the medical home and its potential to transform primary care and improve the quality, safety, efficiency, and effectiveness of U.S. health care.
  • A Guide to Real-World Evaluations of Primary Care Interventions: Some Practical Advice (PDF, 363 KB) presents practical steps for designing an evaluation of a primary care intervention. It answers the questions: Do I need an evaluation? What do I need for an evaluation? How do I plan an evaluation? How do I conduct an evaluation and what questions will it answer? How can I use the findings? What resources are available to help me?
  • The Care Coordination Measures Database/Atlas provides comprehensive profiles of existing measures of care coordination, organizes those measures along two dimensions (domain and perspective), and presents a framework for understanding care coordination measurement, to which the measures are mapped. This framework incorporates elements from other proposed care coordination frameworks and is designed to support development of the field. Users of the CCMD can compare more than 90 validated care coordination measurement tools to identify and select those that are most appropriate for their research and evaluation needs.
  • Using Implementation Research to Guide Adaptation, Implementation, and Dissemination of Patient-Centered Medical Home Models focuses on using implementation research methods in studies of patient-centered medical home (PCMH) models.

Assisting Transformation: Practice Facilitation

  • Practice facilitation is an evidence-based approach to quality improvement in primary care practices. The Primary Care Practice Facilitation Curriculum is designed to assist in the training of new practice facilitators (also known as practice coaches, quality improvement coaches, or practice enhancement assistants) as they begin to develop the knowledge and skills needed to support meaningful improvement in primary care practices.
  • The Practice Facilitation Handbook is designed to assist in the training of new practice facilitators as they begin to develop the knowledge and skills needed to support meaningful improvement in primary care practices.
  • A How-To Guide on Developing and Running a Practice Facilitation Program (PDF, 3 MB) is for organizations interested in starting a practice facilitation program designed to work with primary care practices on quality improvement activities, with an emphasis on primary care redesign and transformation. It is intended for organizations or individuals who will develop, design, and administer such programs.
  • How a Practice Facilitator Can Support Your Practice (PDF, 111.5 KB) provides tips and techniques for primary care practices interested in getting started with quality improvement activities and describes the benefits of working with a practice facilitator (quality improvement coach).

Integrating Behavioral Health and Primary Care

  • Integration Playbook is a Web-based, complete, and concise set of instructions on implementing integration of behavioral health and primary care. Information in the Playbook can be applied to any primary care practice context, no matter how large or small the practice. The Playbook offers tips and examples primary care in mind, but can easily translate to medical specialties.
  • Lexicon for Behavioral Health and Primary Care Integration is a set of concepts and definitions for behavioral health and primary care integration.
  • Atlas of Integrated Behavioral Health Care Quality Measures aims to support the field of integrated behavioral health care measurement by:

    1. Presenting a framework for understanding measurement of integrated care.
    2. Providing a list of existing measures relevant to integrated behavioral health care.
    3. Organizing the measures by the framework and by user goals to facilitate selection of measures.

Creating Teams and Team-based Care

  • TeamSTEPPS® for Office-Based Care Version is an office-based version of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). It adapts the core concepts of 20 years of evidence in the application of teamwork principles to building high-functioning teams specifically in office-based settings. The examples, discussions, videos, and exercises are tailored to the ambulatory care environment.
  • Creating Patient-Centered Team-Based Care is a white paper to stimulate further discussion about how to integrate the principles of patient-centered care into workforce reconfigurations and other aspects of the transition to new primary care models. In addition, the identified strategies can serve as a starting point for investigations into the effectiveness of interventions to provide patient-centered team-based primary care.

Improving Health Literacy

Integrating Quality Improvement

  • Improving Your Laboratory Testing Process is a newly revised AHRQ toolkit that provides a step-by-step guide on how to improve the safety and accuracy of the diagnostic testing process in primary care settings. The guide, an update of a 2013 AHRQ toolkit, can help primary care teams assess how laboratory tests are managed and how the process flows from ordering to follow-up. Approximately 40 percent of medical office visits involve diagnostic testing, with a total of more than 2 billion lab tests performed annually in the United States, predominantly in ambulatory care settings. The majority of errors that occur in the laboratory testing process are related to communication breakdowns.
  • Confidential feedback reporting is widely considered to be a precursor to and a foundation for performance improvement. However, to enable change, the physician responsible for and capable of change must receive, understand, and act on the information. Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance informs developers of feedback reports about evidence-based strategies to consider when developing or refining a feedback reporting system.
  • Will It Work Here? A Decision-maker's Guide to Adopting Innovations can help you determine if an innovation would be a good fit—or an appropriate stretch—for your health care organization by asking a series of questions. It links users to actionable Web-based tools and presents case studies that illustrate how other organizations have addressed these questions.

Optimizing Health IT & Workflow

  • Guide to Reducing Unintended Consequences of Electronic Health Records is an online resource designed to help you and your organization anticipate, avoid, and address problems that can occur when implementing and using an electronic health record. The Guide provides practical, troubleshooting knowledge, and resources.
  • Core Functionality in Pediatric Electronic Health Records examines features needed in pediatric electronic health record systems to ensure quality care for children.
  • Workflow Assessment for Health IT is a toolkit is designed for people and organizations involved in the planning, design, implementation, and use of health information technology in ambulatory care to help reorganize and improve clinical and administrative workflow.
  • The Community-Acquired Pneumonia Clinical Decision Support Implementation Toolkit is a resource to help clinicians and clinical informaticians in primary care and other ambulatory settings implement and adopt the CAP clinical decision support (CDS) alert for the management of community-acquired pneumonia. The CAP CDS alert is based on the CURB-65 tool that assesses CAP severity and recommends site of care (e.g., hospital or home) based on five clinical factors: patient confusion, uremia, elevated respiratory rate, low blood pressure, and age 65 years or older. Uremia is used in emergency departments that have ready laboratory access, but primary care practices use only the four other risk factors. Scores from 0 to 4 or 5 determine the appropriate site of care, with the higher score indicating higher severity of illness.
  • Examining the Relationship Between Health IT and Ambulatory Care Workflow Redesign (PDF, 3.42 MB) documents how workflow changed in six primary and specialty care medical offices after health IT systems were implemented.
  • Patient-Reported Health IT and Workflow (PDF, 3.9 MB) documents workflow impacts of applications that allow patients to share information with primary care providers electronically.
  • Using Health Information Technology to Support Quality Improvement in Primary Care is a white paper describing factors that support the use of health information technology (IT) for quality improvement (QI) in primary care, discusses exemplary cases, and makes recommendations to support and increase the use of health IT to improve the quality of health care delivery and population health outcomes. It is designed for use by practice facilitators and other quality improvement "agents" to help them optimize practices' health IT capabilities for QI purposes (in addition to the use of health IT for clinical care).
  • Health IT-Enabled Care Coordination and Redesign in Tennessee (PDF. 3.1 MB) highlights opportunities to improve the impact of health IT on care coordination activities in primary care.
  • The CDS Connect Project demonstrates a web-based repository service to enable the Clinical Decision Support (CDS) community to identify evidence-based standards of care, translate and codify information into an interoperable standard, and leverage tooling to promote a collaborative model of CDS development

Assessing Patient Experience & Satisfaction

  • The Clinician & Group Survey of the Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) assesses patient experiences with health care providers and staff in doctors' offices. Survey results can be used to: improve care provided by individual providers, sites of care, medical groups, or provider networks; equip consumers with information they can use to choose physicians and other health care providers, physician practices, or medical groups. The survey includes standardized questionnaires for adults and children. The adult questionnaire can be used in both primary care and specialty care settings; the child questionnaire is designed for primary care settings, but could be adapted for specialty care. Users can also add supplemental items to customize their questionnaires.
Page last reviewed August 2018
Page originally created August 2017
Internet Citation: Tools and Resources for Practice Transformation and Quality Improvement. Content last reviewed August 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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