Introduction

Among the most promising quality improvement (QI) interventions for small primary care practices are those led by practice facilitators (PFs), specially trained individuals who help practices develop capacity for continuous QI.1 2 They provide coaching on best practices for QI implementation, including using technology to improve care.3 PF-led QI initiatives are positively associated with guideline adoption,4 5 and may be cost-neutral if they reduce even a small number of high cost events (eg, admissions).6 As part of Healthy Hearts in the Heartland (H3), a programme from the Agency for Healthcare Research and Quality’s EvidenceNow initiative, PFs worked with small and medium-sized primary care practices to implement QI strategies for cardiovascular disease prevention.7 To identify lessons learnt from the programme, we interviewed practice leaders and PFs from practices that experienced the largest and smallest gains in quality scores to understand their experiences.