EvidenceNOW: Evaluation Measures

EvidenceNOW cooperatives will collect practice-level data from participating primary care practices on the clinical quality measures that correspond to each of the ABCS of heart health. The EvidenceNOW evaluation measures were initially determined by AHRQ and then refined by the cooperatives and the national evaluation team. The ABCS measures align with HHS Million Hearts® and are used by other programs such as the CMS Physician Quality Reporting System (PQRS) and are endorsed by the National Quality Forum (NQF).

Clinical Quality Measures

Measure Description

Measure ID (if applicable)

Aspirin use (A)

Percentage of patients with ischemic vascular disease (IVD) receiving aspirin

NQF 0068

Blood pressure control (B)

Percentage of patients 18-85 with hypertension with blood pressure controlled (<140/90)

NQF 0018

Cholesterol management (C)

Percentage of patients with IVD, diabetes mellitus (DM), or low-density lipoprotein (LDL) > 190 receiving a statin

Newly developed measure based on 2013 American Heart Association (AHA)/American College of Cardiology (ACC) guidelines

Smoking cessation (S)

Percentage of patients > 18 who were screened for tobacco use, and percentage of patients who received cessation counseling intervention if identified as a tobacco user

NQF 0028

Practice Measures

EvidenceNOW cooperatives will also collect contextual information from practices to gain an understanding of their processes and environment. The surveys include items assessing practice capacity (using validated Adaptive Reserve and Change Process Capability Questionnaires), burnout, practices’ readiness to implement quality improvement interventions, and clinician attitudes towards new blood pressure and cholesterol guidelines. The surveys also include questions related to EHR use and practice demographics.

Cooperative Evaluation Designs

Each EvidenceNOW cooperative is implementing an evaluation tailored to their aims and regional considerations. The cooperatives will use stepped wedge, cluster randomized, and factorial designs to evaluate their interventions.

Cooperative

Evaluation Methods

Midwest

  • Practices are randomized into two different implementation arms in three waves.
  • Randomization considers practice EHR use in addition to other contextual aspects of the practices.
  • A sustainability observation period will follow the implementation phase.

New York City

  • All practices start as a control prior to block randomization.
  • Randomization of practices occurs in four waves every 3 months.

North Carolina

  • All practices start as a control and receive the intervention at a randomized time point, and then enter a maintenance period after a year.
  • Interventions are randomized based on practice region and readiness

Northwest

  • Practices are randomized based on a 2x2 factorial design with expert consultation on the ACC/AHA heart risk calculator, or site visits to exemplar practices, both interventions, or neither.
  • All practices receive coaching.
  • Practices will be stratified by State to control for context.

Oklahoma

  • Practices are randomized by practice pairs (“pods”) in each county that are geographically close; the two practices in each pair are in different waves of the study.
  • Evaluation is a stepped-wedge design with four waves.
  • A second randomization assigns which two ABCS categories practices will focus on first.

Southwest

  • Design is a two-arm cluster randomized trial.
  • Practices are randomized to three cohorts with phased intervention initiation and an external matched control group.
Virginia
  • Practices are assigned using block randomization, with stratification across five geographic regions and by practice size.
  • Design also includes a survey on “joy of practice” and focus groups with providers.

Learn more about stepped wedge design.

For More Information

For more information about EvidenceNOW evaluation methods, contact AHRQ’s EvidenceNOW Technical Assistance Center at TAC@evidencenowexchange.org.

Page last reviewed October 2016
Page originally created October 2016
Internet Citation: EvidenceNOW: Evaluation Measures. Content last reviewed October 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/evidencenow/evaluation/evaluation-measures.html