Self-management support (SMS) provided by primary care practice teams is recognized as an important component of the care model and patient centered medical home. The burden of chronic illness calls for team- based primary care working in partnership with activated informed patients. It is recognized that few patients are proficient in self-management skills, lacking knowledge and confidence. Primary practices are increasingly dedicating resources to care coordination-identifying and training care managers within the practice to help manage an increasingly complex panel of patients. The Agency for Healthcare Research and Quality (AHRQ) has developed a web-based set of resources and tools to assist busy practices with promoting and delivering patient self-management skills coping with the burden of chronic illness. This proposal from the Meta-LARC consortium of practice-based research networks (PBRNs) will utilize an innovative community participatory implementation intervention, Boot Camp Translation (BCT) to promote and study the implementation of ARHQ's SMS Library/Toolkit across 16 small- and medium-sized primary practices in four PBRNs. The Implementing Networks'Self-management Tools Through Engaging Patients and Practice (INSTTEPP) project will address three specific aims: 1) Implement the AHRQ SMS Library/Toolkit across four participating networks and 16 practices using Boot Camp Translation in a stepped-wedge design~ 2) Assess the impact of implementation on practice staff and patients engaged in chronic illness management~ and, 3) Identify the factors related to successful implementation. INSTTEPP describes four hypotheses: 1) Boot Camp Translation will have positive influences on the attitudes and behaviors of practice staff regarding patient self-management skills~ 2) BCT will positively influence the adoption of the AHRQ SMS Library/Toolkit~ 3) BCT and use of the AHRQ SMS Library will positively influence the attitudes of patients engaged in practice care management programs toward self-management~ and, 4) Identifiable factors within the Theory of Planned Behavior (TPB) and the Consolidated Framework for Implementation Research (CFIR) will impact the adoption of the AHRQ Library/Toolkit by practices. INSTTEPP will provide a model of working in partnership with PBRNs to effectively use BCT to effectively clinicians, clinic staff, and patients in using the AHRQ SMS Library/Toolkit to increase knowledge and use of self-management skills for chronic illness care. The assessment of SMS utility factors identified by TPB and CFIR and informed by qualitative comparative analysis will provide a roadmap for additional research in chronic illness care.
Primary care practices face an unsustainable burden in caring for an increasingly complex patient population with multiple, chronic health conditions. Promoting the development of activated, informed patients who are confident and proficient in self-management skills is an essential role for primary care practices. Our proposed study, Implementing Networks'Self-management Tools through Engaging Patients and Practices (INSTTEPP) proposes an enhanced practice-patient partnership model, Boot Camp Translation, to increased patient skills and engagement in improving their health.