ROCKVILLE, Md. - The Agency for Healthcare Research and Quality (AHRQ) today released early findings from EvidenceNOW, a multimillion dollar initiative to help primary care practices across the country more rapidly improve the heart health of Americans. This $112 million grant-funded initiative is the largest primary care research investment in the agency's history.
Early findings from the initiative, described below, have been published as a supplement to the Annals of Family Medicine. The supplement consists of eight original research articles, an overview and rationale from AHRQ, and two commentaries from nationally recognized experts in primary care research and practice transformation.
EvidenceNOW is aligned with the U.S. Department of Health and Human Services Million Hearts® initiative and is aimed at reducing the research-to-practice delay in implementing best practices to deliver the ABCS of cardiovascular disease prevention: aspirin in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation.
The multi-state EvidenceNOW initiative engaged 1,500 small- to medium-sized primary care practices and nearly 8 million patients. It established seven regional cooperatives designed to provide quality improvement services typically not available to small practices.
"EvidenceNOW's goal is to measurably improve the health of Americans through the delivery of evidence-based primary care and build a blueprint of how to provide small- and medium-sized primary care practices with quality improvement support", says David Meyers, AHRQ's chief medical officer and EvidenceNOW director. "Primary care is the backbone and heart of U.S. health care delivery. This supplement will help the field better understand the impact AHRQ has on primary care and heart health, helping them tackle the challenges they are facing today, with solutions that will make for a promising future."
The initiative also includes an independent national evaluation to determine if and how quality improvement support can accelerate the dissemination and implementation of new evidence in primary care.
Findings include the following:
- Recruiting Practices is Costly
Recruiting practices for large scale quality improvement initiatives is difficult and costly ($5,529 per enrolled practice on average), and even more expensive for practices with no prior relationship with the study team.
"Technical Assistance for Primary Care Practice Transformation: Did You Budget Enough For Practice Recruitment?," by Lyle Fagnan, MD, et al, Portland Oregon
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- Hospital Ownership of Practice May Reduce Burnout
Among staff in small- to medium-sized primary care practices, hospital ownership is associated with positive perceptions of work environment and lower burnout.
"Effect of Practice Ownership on Work Environment, Learning, Culture, Psychological Safety, and Burnout," by Alison Cuellar, PhD, et al, Fairfax, Virginia
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- Solo Practices Outperform Groups in Meeting ABCS Targets
Solo primary care practices in New York City are more likely than group practices to meet practice guidelines for reducing cardiovascular risk.
"Quality of Cardiovascular Disease Care in Small Urban Practices," by Donna Shelley, MD, MPH, et al, New York, New York
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- Major Disruptions are Frequent in Primary Care
Among 208 primary care practices, two-thirds experienced one or more major disruptive events, such as personnel changes or relocation, adversely affecting quality improvement efforts.
"The Alarming Rate of Major Disruptive Events in Primary Care Practices in Oklahoma," by James W. Mold, MD, MPH, et al, Oklahoma City, Oklahoma
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- Quality Improvement Systems Influence Small- to Medium-Sized Practice Use of Quality Improvement Strategies
Small- to medium-sized practices with quality improvement systems (e.g., registries) are most likely to use quality improvement strategies. Practices with fewer major disruptions are more likely to use quality improvement strategies to improve cardiovascular preventive services.
"Use of Quality Improvement Strategies Among Small- to Medium-Size US Primary Care Practices," by Bijal Balasubramanian, MBBS, PhD, et al, Dallas, Texas
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- Leadership and Adaptive Reserve Are Not Associated With Blood Pressure Control
Primary care leadership and practice resilience can strengthen organizational culture. In small primary care practices, however, practice adaptive reserve and leadership capability are not associated with baseline blood pressure control.
"Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study," by Kamal H. Henderson, MD, et al Chapel Hill, North Carolina
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- Interventions to Decrease Cardiovascular Disease are Not One-Size-Fits-All
In a study spanning four culturally different communities, tailored recruitment materials were developed to facilitate community engagement.
"A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health," by Aimee F. English, MD, et al, Denver, Colorado
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- Practice Leaders' and Facilitators' Perspectives on Quality Improvement May Differ
Practice facilitators and practice leaders agreed on the value of a facilitated quality improvement program, but reached different judgments on practices' intensity and pace of change.
"Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program," by Megan McHugh, PhD, et al, Chicago, Illinois
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EDITORIALS AND OVERVIEWS
- What do Small Primary Care Practices Need to Transform?
In order to transform amidst the many demands they face, primary care practices require a new set of conditions. According to editorialist Lawrence Casalino, MD, PhD, practices need more time and resources (through less time-consuming electronic health records, reduced reporting requirements, and more equitable reimbursement); reimbursement that is partly prospective rather than wholly fee-for-service; financial rewards for good performance on quality, cost, and patient experience; and shared resources for improving care. The EvidenceNOW initiative, he suggests, will be a rich source of information on technical assistance for small practices.
"Technical Assistance for Primary Care Practice Transformation: Free Help To Perform Unpaid Labor?," by Lawrence P. Casalino MD, PhD, New York City, New York
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- Tenets for Primary Care Practice Transformation
Editorialist Asaf Bitton, MD, MPH, outlines four principles for primary care practice transformation. He calls on practices to 1) Look beyond short-term fixes to large-scale, holistic practice change; 2) Pace themselves, making change over time; 3) Focus on the most beneficial primary care outcomes for patients and communities; and 4) Work on the change process as a team.
"Finding a Parsimonious Path for Primary Care Practice Transformation," by Asaf Bitton, MD, MPH, Boston, Massachusetts
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- EvidenceNOW: Insights Into Implementation Research
EvidenceNOW grew out of a rapidly changing primary care landscape and the urgent need for knowledge about practice transformation. This article describes AHRQ's decision-making processes as they designed the initiative's structure, which allows for local adaptation under a national umbrella, and their focus on producing evidence-based tools and improvement resources that will be applicable to most primary care practices in the United States.
"EvidenceNOW: Balancing Primary Care Implementation and Implementation Research," by David Meyers, MD, et al, Rockville, Maryland
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- Supporting New Models of Care for Primary Care Practice
Primary care practices are expected--now more than ever--to meet the needs of a complex and aging population, often under significant time constraints and regulatory burdens. Early findings from EvidenceNOW will help pave the way to the delivery of higher quality, comprehensive, team-based, patient-centered care, while helping primary care practices use health information technology to effectively manage population health and ongoing practice improvement.
"The Capacity of Primary Care for Improving Evidence-Based Care: Early Findings From AHRQ's EvidenceNOW," by Sarah Shoemaker, PhD, PharmD, et al, Cambridge, Massachusetts
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About the Annals of Family Medicine
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's website, http://www.