A systematic approach to practice assessment and quality improvement intervention tailoring.
BACKGROUND
The ways in which tailored interventions foster sustained improvement in the quality of health care delivery across different practice settings are not well understood. Using the empirically developed Practice Change Model (PCM), we identify and describe assessment and tailoring activities with potential to enhance the fit between proposed interventions and practice settings.


METHODS
We obtained quantitative and qualitative data from 2 quality improvement trials conducted in diverse primary care practices in northeast Ohio. A multidisciplinary team used a PCM-based template to identify features of practice assessment and tailoring associated with practices' willingness and ability to change.


RESULTS
Our results suggest that intervention tailoring requires assessment of key stakeholders' motivations, external influences, resources and opportunities for change, and the interactions between these factors. Using this information, intervention tailoring then includes seeking and working with key stakeholders, building assets, providing options, keeping change processes flexible, offering feedback, providing exposure to scientific evidence, facilitating group processes, involving new partners, brainstorming, using stories/play acting/humor, assuming a consultant role, reframing, moving meetings off-site, and stepping back or pausing.


CONCLUSIONS
A model-driven approach guiding practice assessment enables tailored responses to the unique and emerging conditions that distinguish health care practices and influence implementation of quality management interventions.
Department of Family Medicine, Cleveland, OH, USA. Mary.Ruhe@case.edu
Mary C
MC
Ruhe
Caroline
C
Carter
David
D
Litaker
Kurt C
KC
Stange
D019317:Evidence-Based Medicine; D018166:Health Care Reform; D006801:Humans; D017146:Models, Organizational; D009820:Ohio; D009936:Organizational Innovation; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D016032:Randomized Controlled Trials as Topic