The Origins of AHRQ’s EvidenceNOW: Advancing Heart Health in Primary Care
Primary Care Matters
Primary care is the foundation of our Nation’s health care system. It is where most people go when they need care, and it is able to provide them with help for urgent problems, chronic conditions, and support in navigating the larger health care system. Studies show that nations that maintain strong primary care systems are more likely to have better overall health and more efficient health care systems.
America’s Primary Care System Is Under Pressure
Over the last two decades, factors have combined to create a storm of stressors for this vital health care system. America’s population is both growing and aging. While resources and the number of primary care physicians have remained stable, more patients are coming to primary care, and many of those patients have conditions requiring more complex treatment and coordination. In order to continue delivering care of the highest quality, America’s primary care system needs support in adapting to these new realities.
AHRQ’s Commitment to Supporting Primary Care
The mission of the Agency for Healthcare Research and Quality (AHRQ) is to create evidence and help the health care system implement that evidence to continually improve quality, safety, and value in health care. Recognizing that a robust primary care system is necessary to achieving an effective health care system that serves all Americans, AHRQ has made a commitment to revitalizing the Nation’s primary care system.
New Models Emerge
Over the last decade, AHRQ has led the way in developing new initiatives to support primary care. Among these were studies of the patient-centered medical home (PCMH).
The PCMH model is a team-based approach focused on delivering patient-centered, coordinated primary care. AHRQ has demonstrated that the PCMH can improve quality, control costs, and improve the health care experience for a growing population of patients.
A Question of Keeping Pace
Even as these new models are developing and spreading, primary care professionals must maintain their proficiency in a range of medical knowledge that spans nearly every area of medicine. And new medical knowledge continues to expand and change at an ever-increasing rate. The challenge for primary care has quickly become: how can we keep pace with new information, learn how to best implement it in our practices, while also continuing to serve a full schedule of patients?
A New Focus for Evidence
In response to the growing amount of new information, a new approach has emerged for evaluating medical evidence and its implementation: patient-centered outcomes research (PCOR).This new approach focuses on the things patients care about, such as pain, symptoms, course of illness, and quality of life. It compares different treatments, approaches, and interventions to understand which are most effective for which people and under what circumstances. PCOR has quickly become foundational to advancing all aspects of America’s health care systems.
A Potential Solution Emerges
Through its work on practice transformation, AHRQ learned that small primary care practices often lacked the internal resources to implement new models of care such as the PCMH. Through its research AHRQ discovered that externally provided quality improvement support, including practice facilitation, accelerated transformation of primary care practices. AHRQ became interested in exploring whether practice facilitation could also support primary care teams in learning about new evidence and putting it into practice.
The Affordable Care Act Sets the Wheels in Motion
In 2010, the Affordable Care Act (ACA) was signed into law. The ACA created the Patient-Centered Outcomes Research Trust Fund (PCORTF), providing funds to help build the Nation’s PCOR capacity and for AHRQ to advance the work of dissemination and implementation of PCOR findings into practice. These funds allowed AHRQ to move forward with a robust primary care external support test program.
HHS Million Hearts® Provides Opportunity for Alignment
In 2012, the U.S. Department of Health and Human Services (HHS) launched Million Hearts®, a national initiative with the aim of preventing one million heart attacks and strokes in 5 years by empowering people to make healthy choices and improving care for those who need it. The goal of improving care focuses on the "ABCS" of cardiovascular care: A for aspirin for those at risk of a heart attack, B for blood pressure control, C for cholesterol management, and S for smoking cessation.
In alignment with Million Hearts, AHRQ proposed an initiative of providing primary care practices with external quality improvement support with the goal of improving the delivery of the ABCS to millions of Americans.
A Bold Initiative Takes Shape
In March of 2014, AHRQ made the funding announcement for a $112 million grant initiative to study if and how external quality improvement support helps small- and medium-sized primary care practices implement PCOR evidence to improve the health of their patients.
AHRQ developed this bold initiative to determine whether quality improvement support could both increase the dissemination and implementation of PCOR evidence into practice and leave practices with increased capacity for understanding and using PCOR evidence in the future. Equally importantly, by increasing the delivery of the ABCS in primary care, the initiative will make a substantial contribution to helping fight America’s number one killer, heart disease.
AHRQ Launches EvidenceNOW
In May of 2015, AHRQ officially launched the EvidenceNOW: Advancing Heart Health in Primary Care, awarding grants to seven regional cooperatives and one independent evaluation organization.
The seven cooperatives will work across 12 States to provide support services to more than 1,500 small- to medium-sized independent primary care practices. Each cooperative brings together the skills, expertise, and resources of regional organizations including local, State, and regional primary care organizations, academic institutions, organizations dedicated to improving care, public health agencies, community-based organizations, public payers, and patient and consumer groups.
The cooperatives will provide and study five key areas of practice improvement support services: on-site facilitation and coaching, data feedback and benchmarking, electronic health record support, expert consultation, and shared learning collaboratives.
Throughout the initiative, the evaluation will reveal the impact of the cooperatives’ interventions on practice improvement and the effects on primary care quality. It will also demonstrate which practice support services are most effective in improving the implementation of new medical evidence.
A New Blueprint for Improving Primary Care
AHRQ is committed to revitalizing the Nation’s primary care system to meet the challenges of the 21st Century. The EvidenceNOW grant initiative promises to advance the quality of primary care across America. Primary care improvement strategies have never before been broadly studied at this scale. The learning will answer many important questions and propel significant improvements in care delivery.
Our Nation’s primary care system provides quality care to millions of people every day. With success, EvidenceNOW will create a new blueprint for making lasting improvements in America’s primary care system, as it improves America’s heart health, and saves lives.
Learn more about the origins of the EvidenceNOW evaluation in an interview with David Meyers, M.D., Chief Medical Officer of AHRQ.
Page originally created October 2016