title: Study protocol for "Healthy Hearts Northwest": a 2 × 2 randomized factorial trial to build quality improvement capacity in primary care.
abstract: Little attention has been paid to quality improvement (QI) capacity within smaller primary care practices which comprise nearly half of all primary care settings. Strategies for external support to build such capacity include practice facilitation (PF), shared learning opportunities, and educational outreach. Although PF has proven effectiveness, little is known about the comparative effectiveness of combining these strategies. Here, we describe the protocol of the "Healthy Hearts Northwest" (H2N) study, a randomized trial designed to address these questions while improving risk factors for cardiovascular disease.
  
  
  
  The targeted enrollment is 250 smaller primary care practices across Washington, Oregon, and Idaho. The study is utilizing a two-by-two factorial design to assess four different combinations of practice support: PF alone, PF with educational outreach, PF with shared learning opportunities, or PF with both. A mixed methods approach is being used for evaluation and will include data from (1) baseline and follow-up practice and staff surveys; (2) baseline and quarterly clinical performance measurement from each practice on four cardiovascular risk factors: appropriate aspirin use, blood pressure control, lipid management and smoking cessation support; and (3) a quality improvement capacity assessment (QICA) survey used by external practice facilitators to guide improvement efforts.
  
  
  
  Results from this study will inform future large-scale practice improvement initiatives by providing comparisons of promising external practice support strategies and advance our understanding of how to build QI capacity in primary care.
  
  
  
  ClinicalTrials.gov, NCT02839382.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA. parchman.m@ghc.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.affiliation: Oregon Rural Practice Research Network, Oregon Health Sciences University, Portland, USA.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Fagnan
authors.affiliation: Department of Medicine, Oregon Health Sciences University, Portland, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Dorr
authors.affiliation: Qualis Health, Seattle, Washington, USA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Evans
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Cook
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Hsu
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Cheadle
authors.affiliation: Department of Family Medicine and the Institute of Translational Health Sciences, University of Washington, Seattle, USA.
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
mesh_terms: D035843:Biomedical Research; D057191:Capacity Building / Q000379:methods*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007061:Idaho; D009922:Oregon; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement; D012107:Research Design; D012307:Risk Factors; D014861:Washington
keywords: Cardiovascular diseases; Primary health care; Quality improvement