About EvidenceNOW: Background and Stories from the Field

Goals of EvidenceNOW

AHRQ launched EvidenceNOW, a $112 million effort and one of AHRQ’s largest primary care research projects to date, in 2015 with the goal of accelerating the adoption of evidence-based care in small- and medium-sized primary care practices across the country.

EvidenceNOW is designed to help smaller primary care practices improve their ability to integrate the best available clinical evidence more quickly and effectively into patient care. The program focuses on heart disease prevention and the ABCS of heart health—four evidence-based services proven to prevent heart attacks and strokes—to simultaneously address the use of evidence in primary care while helping to prevent heart disease, the number one cause of death in the United States.

The ABCS of Heart Health

  • Aspirin for individuals at high risk of heart attack and stroke
  • Blood pressure control
  • Cholesterol management
  • Smoking cessation

Components of EvidenceNOW

EvidenceNOW established seven regional cooperatives composed of public and private health partnerships and multidisciplinary teams of experts in 12 States. Each cooperative met its recruitment goal and enrolled 200–250 small- and medium-sized primary care practices (1,500 practices total) to participate in the initiative.

EvidenceNOW has quality improvement services with on-site facilitation and coaching, health IT support, shared learning collaboratives, expert consultation, and data feedback and benchmarking.The cooperatives developed customized interventions for the practices, combining five core services that are usually not available to smaller practices because of their size:

  • On-site practice facilitation and coaching.
  • Health information technology support.
  • Shared learning collaboratives.
  • Expert consultation.
  • Data feedback and benchmarking.

These combined services were designed to improve practices’ use of the best medical evidence in patient care, including current clinical guidelines on heart health, findings from patient-centered outcomes research, and patient health data. Each cooperative's approach to providing these services was tailored to their geographic region and populations.

Each cooperative collected data to analyze the effects of their interventions on primary care practice and heart health. AHRQ also funded an independent national evaluation of the overall EvidenceNOW initiative. The national evaluation team is studying the impact of cooperatives’ interventions on practice improvement and heart health care. In addition, the evaluation team is looking at which practice support services and quality improvement strategies are most effective in improving the implementation of new medical evidence.

The national evaluation is scheduled for completion in 2019.

The timeline for the EvidenceNOW initiative began with a funding announcement in March 2014 followed by the launch of the initiative in May 2015. The practice recruitment period is May 2015 through January 2016, and baseline data are collected at the end of that period. Implementation of quality improvement initiatives and ongoing data collection will take place starting in February 2016, ending in November 2017. The post-intervention evaluation of the initiative will be completed from November 2017 through May 2018.

What We’re Learning

The EvidenceNOW national and regional evaluations have already revealed a number of insights since fall 2017, including:

  • Many practices participating in EvidenceNOW were already delivering some of the individual ABCS services to 70 percent or more of their patients, but almost all practices had room for improvement.
    • Learn more from this infographic on practices’ delivery of ABCS services before EvidenceNOW.
  • Smaller primary care practices face hurdles in implementing evidence-based care into practice, including:
    • High rates of staff turnover and clinician burnout
    • Limited use of electronic health records and patient data to support quality improvement activities
    • Communication gaps with larger parent health systems or regional health information exchanges
    • Limited capacity for quality improvement projects
      • For more detail, see this infographic on practices’ capacity for quality improvement before EvidenceNOW.

What kinds of practices participated in EvidenceNOW?

  • 1 in 3 operate in medically underserved areas
  • 75% have 5 or fewer clinicians
  • 41% are clinician-owned

In an Annals of Family Medicine supplement, EvidenceNOW researchers describe these hurdles and underscore the significance of EvidenceNOW’s support for small- and medium-sized practices to tackle them. Some of the insights and solutions explored in this supplement include:

  • Practice staff (not just clinicians) play critical roles in fostering positive perceptions of the work environment and reducing staff burnout.
  • Patient and community input helps develop heart disease prevention materials that are tailored to local needs and values.
  • Primary care practices experience an alarming rate of major disruptive events such as staff turnover and changes in ownership. Observing organizations that have successfully managed these changes may lead to solutions for others facing similar challenges.
  • Targeted efforts to facilitate changes in primary care are better received than large-scale quality improvement programs.
  • Practices with certain characteristics are more likely to use quality improvement strategies than other practices. These characteristics include participation in accountable care organizations, producing quality reports and reports from electronic health records, or discussing clinical quality data in staff meetings.

Impact on Primary Care

Learning Health Systems: Practice, Data, KnowledgeEvidenceNOW supports the evolution of health care delivery organizations into learning health systems that continuously learn from available evidence and data to provide high quality, safe, and efficient care. Since its inception, EvidenceNOW has made a difference in individual practices’ day-to-day work, such as:

  • Sharing evidence-based guidelines with thousands of primary care clinicians to improve care for patients.
  • Linking hundreds of practices to regional health information exchanges.
  • Developing dashboards so clinicians can use data to manage patient care more effectively.
  • Coaching care teams on ways to identify high-risk patients to better target evidence-based preventive services like aspirin and cholesterol medication.

EvidenceNOW is shining a light on the type of supports that help primary care practices achieve improved health outcomes—including how best to spread the results of patient-centered outcomes research to primary care practices and how to assist practices in using this research to deliver better care to their patients.

Ultimately, findings from EvidenceNOW will create a blueprint for strengthening the Nation’s primary care system and improving its capacity to deliver high-quality, evidence-based, patient-centered care.

Page last reviewed October 2018
Page originally created October 2016
Internet Citation: About EvidenceNOW: Background and Stories from the Field. Content last reviewed October 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/evidencenow/about/index.html