Virtual Practice Facilitation and Implementation of Cardiovascular Quality Improvement Strategies in Primary Care Clinics: A Descriptive Study

Practices that used a mix of virtual and in-person support made greater gains in implementing quality improvement strategies than those relying only on traditional, in-person coaching.

That’s the top-line finding from a new peer-reviewed study co-authored by Anya Day, MPH, Vice President at Altarum, and Carrie Butt, Quality Improvement Project Manager and Lead Practice Facilitator at Altarum.  

Published in The Joint Commission Journal on Quality and Patient Safety, the paper is available at no cost through July.

The study draws on lessons from the Healthy Hearts for Michigan (HH4M) initiative, a multi-year effort led by Altarum to strengthen cardiovascular care in rural and underserved communities. Through HH4M, Altarum partnered with more than 50 primary care practices across Michigan to improve hypertension management and smoking cessation—two leading risk factors for cardiovascular disease.

At the center of this work is practice facilitation: hands-on, tailored support that helps care teams implement evidence-based interventions and strengthen workflows, building the internal capacity to continue that work on their own.

As QI programs shifted from in-person to hybrid and virtual support during COVID-19, HH4M incorporated virtual facilitation alongside on-site engagement. The findings are straightforward: the right modality depends on the type of work, not a preference for virtual vs. in-person.

• Virtual facilitation is well-suited to information-sharing work: reviewing performance data, introducing tools, and supporting patient education
• In-person facilitation is critical for hands-on change: observing care delivery, refining workflows, and supporting real-time problem solving

Practices that combined both approaches, using each where it is strongest, outperformed those that relied on a single mode of support.

This reinforces a broader lesson: effective facilitation is not about delivering ongoing support to practices, but about equipping teams to carry the work forward themselves.

For Altarum, these findings reflect how we approach improvement work in practice: not as a one-time transfer of knowledge or a service model organizations must rely on, but as work that builds capability within care teams. That means pairing flexible, scalable support with targeted, hands-on engagement, so practices can sustain that work over time.

“These findings remind us that sustainable health care improvement is not about creating long-term dependence on external support; it’s about building the capacity for an organization to continue improving, long after a project ends,” Butt explains. “What stood out most from this work was that the strongest outcomes came from using both virtual and in-person facilitation intentionally, matching the approach to the type of support practices needed in the moment. That flexibility allowed us to expand reach while still maintaining the hands-on partnership necessary to drive meaningful change in patient care.”

As health systems continue to prioritize measurable outcomes and sustainable improvement, this work highlights a practical path forward—one that expands reach without sacrificing effectiveness, strengthening the internal capacity needed to deliver better care over time.

Access the publication (free through July): The Joint Commission Journal on Quality and Patient Safety