Explorations of workflow development within primary care allow us to understand initial steps in the pace of knowledge and practice acclimatization within clinics. This study describes use of practice facilitation as an implementation strategy to communicate shared project goals and monitor and support refinement of practice behavior. This study engaged eight health care organizations, including 55 primary care practices, ≍380 clinicians and ≍620 nursing and support staff in a guideline implementation project regarding United States Preventive Services Task Force use of aspirin recommendations for primary prevention of cardiovascular events.
Primary care practices are busy places. Clinicians and staff are challenged to address an individual patient’s reason for visit, reconcile medications, manage chronic conditions, advocate prevention, review and respond to lab reports, consults, email and telephone queries. Although researchers determined two decades ago that a lack of time rendered primary care delivery of United States Preventive Services Task Force (USPSTF) A and B graded recommendations impracticable, expectations connected to patient-centered medical home transformation and triple or quadruple aim goals continue to increase time burdens. Time constrained primary care practices will be further challenged by translational science goals involving discovery and development of learning healthcare system capabilities for implementing new therapies. So what do we know about the time it currently takes primary care practices to introduce new knowledge into practice? This brief report begins to address the lack of systematic inquiry by providing preliminary data about the pace of adoption or time to adoption of a USPSTF guideline into the primary care setting.