There is no commonly accepted comprehensive framework for describing the practical specifics of providing external support for practice change. Our goal was to develop such a taxonomy that could be used by both external groups or researchers and health care leaders. This paper reports on a taxonomy developed by the leaders of Agency for Research and Quality (AHRQ) EvidenceNOW initiative and is informed by their experience developing and implementing external support to improve cardiovascular preventive services in over 1500 primary care practices across the U.S. Combining literature reviews with practical experiences in this initiative and past work, this publication aimed to define these domains and recommend measures for them.
The taxonomy outlines key domains that characterize external support interventions. This includes 1 domain to specify the conceptual model(s) on which an intervention is built and another to specify the types of support strategies used. Another 5 domains provide specifics about the dose/mode of that support, the types of change process and care process changes that are encouraged, and the degree to which the strategies are prescriptive and standardized. A model was created to illustrate how the domains fit together and how they would respond to practice needs and reactions.
This paper, published in the Journal of the American Board of Family Medicine demonstrate identifies that these domains can inform how organizations involved in quality improvement respond to practice needs, including facilitators and external groups (e.g., quality improvement organizations, regional extension centers, or area health education centers) as well as health systems leaders and researchers.