EvidenceNOW Supplement in Annals of Family Medicine
Early findings from the EvidenceNOW initiative are now available in a special Annals of Family Medicine journal supplement entitled, The Agency for Healthcare Research and Quality’s EvidenceNOW: Early Findings. Brief summaries of each paper authored by AHRQ, guest editorialists, the EvidenceNOW cooperatives, and the EvidenceNOW National Evaluation Team are provided below.
The Capacity of Primary Care for Improving Evidence-Based Care: Early Findings from AHRQ’s EvidenceNOW
The guest editors provide an overview of the EvidenceNOW supplement.
Shoemaker SJ, McNellis RJ, DeWalt DA. (2018). The capacity of primary care for improving evidence-based care: early findings from AHRQ's EvidenceNOW. Ann Fam Med 2018;16(Suppl 1):S2-S4. http://www.annfammed.org/content/16/Suppl_1/S2.
Invited Commentary: Technical Assistance for Primary Care Practice Transformation: Free Help to Perform Unpaid Labor?
Dr. Lawrence Casalino explores the importance of small primary care practices and the advantages they offer for responsive, adaptable patient care. The author analyzes barriers that small practices face in trying to evolve the care they provide, and he proposes solutions that function in tandem with external support services such as EvidenceNOW that could benefit practices.
Casalino LP. (2018). Technical assistance for primary care practice transformation: free help to perform unpaid labor? Ann Fam Med 2018;16(Suppl 1):S12-S15. http://www.annfammed.org/content/16/Suppl_1/S12.
Invited Commentary: Finding a Parsimonious Path for Primary Care Practice Transformation
Dr. Asaf Bitton reflects on primary care transformation issues surfaced by EvidenceNOW, from transformation challenges to features of practice change associated with higher levels of improvement. The author offers a core set of strategies for care transformation that must occur alongside system-level supports—practices should work on large-scale change holistically, pace themselves, focus on what matters most, and maintain regular quality improvement "hygiene."
Bitton A. (2018). Finding a parsimonious path for primary care practice transformation. Ann Fam Med 2018;16(Suppl 1):S16-S20. http://www.annfammed.org/content/16/Suppl_1/S16.
EvidenceNOW: Balancing Primary Care Implementation and Implementation Research
AHRQ describes the research design decisions made for the EvidenceNOW initiative, including the focus on small- and medium-sized practices, the specific intervention and research strategies, the evaluation, and use of learning communities. The article also addresses the trade-offs between research goals and real-world implementation of quality improvement strategies.
Meyers D, Miller T, Genevro J, et al. (2018). EvidenceNOW: Balancing primary care implementation and implementation research. Ann Fam Med 2018;16(Suppl 1):S5-S11. http://www.annfammed.org/content/16/Suppl_1/S5.
Quality of Cardiovascular Disease Care in Small Urban Practices
This paper by the New York City Cooperative captures the performance of small, urban primary care practices on the four EvidenceNOW heart health care (ABCS) measures before the practices participated in EvidenceNOW. At these practices, two-thirds to three-quarters of patients at risk were meeting the goals for the ABCS of heart health. Among patients with a history of heart disease, less than 50 percent met heart health targets for aspirin use, blood pressure control, and smoking cessation. Researchers also found that solo clinician primary care practices were more likely to meet the aspirin and cholesterol goal than practices with more than one clinician.
Shelley D, Blechter B, Siman N, et al. (2018). Quality of cardiovascular disease care in small urban practices. Ann Fam Med 2018;16(Suppl 1):S21-S28. http://www.annfammed.org/content/16/Suppl_1/S21.
Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study
The North Carolina Cooperative examined small primary care practices’ performance on blood pressure control goals before practices’ participation in EvidenceNOW and the relationship to organizational quality improvement (QI) characteristics. Adaptive reserve and leadership capability in QI were not associated with achieving the target blood pressure goal.
Henderson KH, DeWalt DA, Halladay J, et al. (2018). Organizational leadership and adaptive reserve in blood pressure control: The Heart Health NOW Study. Ann Fam Med 2018;16(Suppl 1):S29-S34. http://www.annfammed.org/content/16/Suppl_1/S29.
Use of Quality Improvement Strategies Among Small- to Medium-Size U.S. Primary Care Practices
The EvidenceNOW National Evaluation Team assessed small- to medium-sized primary care practices’ use of quality improvement strategies at baseline. Practices that participated in accountable care organizations, produced reports from electronic health records (EHRs), produced quality reports, or discussed clinical quality data in meetings use quality improvement (QI) strategies to a greater degree than other practices. Additionally, they found lower use of QI strategies among health-system owned practices and those experiencing a disruptive event.
Balasubramanian BA, Marino M, Cohen DJ, et al. (2018). Use of quality improvement strategies among small- to medium-size US primary care practices. Ann Fam Med 2018;16(Suppl 1):S35-S43. http://www.annfammed.org/content/16/Suppl_1/S35.
Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout
The Virginia Cooperative examined effects of practice ownership on self-reported work environment, culture of learning, psychological safety, and burnout at small- and medium-size primary care practices. Hospital ownership was associated with more positive perceptions of practice work environment, psychological safety, and lower staff burnout, though the effect was largely driven by clinic staff rather than clinicians.
Cuellar A, Krist AH, Nichols LM, Kuzel AJ. (2018). Association between primary care practice ownership, work environment, learning culture, and burnout. Ann Fam Med 2018;16(Suppl 1):S44-S51. http://www.annfammed.org/content/16/Suppl_1/S44.
The Alarming Rate of Major Disruptive Events in Primary Care Practices in Oklahoma
The Oklahoma Cooperative explored major disruptive events in small- to medium-sized primary care practices in Oklahoma, such as practice relocation, changes in ownership and key staff, and implementation of new systems—events that can affect quality and continuity of care. During the practices’ first year participating in EvidenceNOW, nearly one in two practices experienced at least one major disruptive event. Disruptive events reported most often included loss of personnel and implementation of EHRs and billing systems.
Mold JW, Walsh M, Chou A, Homco J. (2018). The alarming rate of major disruptive events in primary care practices in Oklahoma. Ann Fam Med 2018;16(Suppl 1):S52-S57. http://www.annfammed.org/content/16/Suppl_1/S52.
A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health
The Southwest Cooperative describes research design challenges and findings from the use of a community-based intervention called Boot Camp Translation. This intervention focuses on translating evidence-based heart disease prevention strategies into messaging and materials that are relevant and understandable for community members. Findings indicate that this technique yielded messages and materials tailored to different communities, suggesting that heart disease prevention programs are not one-size-fits-all.
English A, Dickinson L, Zittleman L, et al. (2018). A community engagement method to design patient engagement materials for cardiovascular health. Ann Fam Med 2018;16(Suppl 1):S58-S64. http://www.annfammed.org/content/16/Suppl_1/S58.
Practice Facilitators’ and Leaders’ Perspectives on a Facilitated Quality Improvement Program
A qualitative look by the Midwest Cooperative at methods for improving quality improvement approaches, using detailed interviews from primary care practice leaders and the practice facilitators assigned to those practices. Interviews indicated that targeted practice facilitator-supported efforts may be easier to implement in primary care than larger, more extensive quality improvement projects.
McHugh M, Brown T, Liss DT, Walunas T, Persell S. (2018). Practice facilitators' and leaders' perspectives on a facilitated quality improvement program. Ann Fam Med 2018;16(Suppl 1):S65-S71. http://www.annfammed.org/content/16/Suppl_1/S65.
Engaging Primary Care Practices in Studies of Improvement: Budgeting for Practice Recruitment
In this article, the Northwest and Midwest Cooperatives describe the approach, cost, and resources needed to recruit and enroll 500 primary care practices for EvidenceNOW. On average, the cooperatives needed to have seven interactions with practices to enroll them in EvidenceNOW. The recruitment effort required a total of 22,430 hours and $2.675 million, or $5,529 per enrolled practice, across the two cooperatives. Prior relationships with practices or "warm hand-offs" predicted recruitment success, with almost 1 in 3 of those practices enrolling into EvidenceNOW compared to 1 in 20 practices without a prior relationship with cooperative staff.
Fagnan LJ, Walunas T, Parchman ML, et al. (2018). Engaging primary care practices in studies of improvement: budgeting for practice recruitment. Ann Fam Med 2018;16(Suppl 1):S72-S79. http://www.annfammed.org/content/16/Suppl_1/S72.
Visit the Annals of Family Medicine journal supplement to view the full articles.
