EvidenceNOW: Building State Capacity
In States across the Nation, efforts to transform primary care and improve patient outcomes have gained tremendous momentum over the past decade. However, many primary care practices continue to struggle to find and incorporate the best evidence from patient-centered outcome research (PCOR) into patient care. With Federal and State funding, a growing number of States have developed systems and infrastructure to provide quality improvement (QI) support to help primary care practices implement evidence-based interventions. The availability and types of QI support differ significantly across States, which leaves many practices without the kind of support needed to improve care systematically and can contribute to addressing health inequities. Having QI support systems in place may be particularly beneficial for practices in States with higher burdens of disease, for example, those States with higher rates of heart attacks and strokes. Improving the delivery of evidence-based heart health interventions could result in significant improvements in health outcomes.
AHRQ is investing in the development of additional State-based external quality improvement (QI) support infrastructure to increase the capacity of States to help primary care practices deliver evidence-based care and to address equity in health outcomes. In 2021, AHRQ launched EvidenceNOW: Building State Capacity to catalyze the creation or enhancement of such an infrastructure in four States. In order to address disparities, AHRQ sought applications from States whose capacity is currently limited but have the potential to expand primary care improvement activities. It also prioritized States with a high prevalence of preventable cardiovascular events, which account for a significant national health burden and the leading cause of death. AHRQ has established a Technical Assistance Center to help support grantees at every stage of the process.
The goals of EvidenceNOW: Building State Capacity are to:
- Increase dissemination and implementation of PCOR findings using the EvidenceNOW Model to improve health and healthcare.
- Improve heart health in States with high disease burden, with a focus on high blood pressure and tobacco use, and address health disparities.
- Develop sustainable State-level capacity to support primary care quality improvement.
To accomplish these goals, AHRQ has funded four grantees in Alabama, Ohio, Michigan, and Tennessee to establish a sustainable, State-level entity – called a cooperative – that will disseminate PCOR findings by using AHRQ’s EvidenceNOW Model to deliver and coordinate external QI support. Each grantee will:
- Establish a Cooperative that brings together existing State and local resources to disseminate and implement evidence and provide QI support to primary care practices.
- Build a network of primary care practices and related stakeholders across the State that can use the cooperative as a resource for QI support.
- Develop a comprehensive, evidence-based approach for a heart health improvement project involving 50 or more practices to promote adoption of findings from patient-centered outcomes research and build improvement capacity of primary care practices.
- Conduct a comprehensive evaluation of all project phases, including the establishment of the cooperative, development of the network, and heart health improvement project.
- Create a robust dissemination plan to share findings with State and local stakeholders and with other States.
- Integrate sustainability planning throughout the project, including a plan to maintain the cooperative and its network of practices beyond the project conclusion.
Principal Investigator: Andrea Cherrington, MD, MPH, Professor, Division of Preventive Medicine, University of Alabama at Birmingham
Principal Investigators: Anya Day, MPH, Vice President, Operations, Altarum Institute; Gregory Makris, MD, Medical Director & Deputy Center Director, Center for Appropriate Care, Altarum Institute; Theresa L. Walunas, PhD, FAMIA, Assistant Professor, Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University
Principal Investigators: Shari Bolen, MD, MPH, Associate Professor of Medicine, Population and Quantitative Health Sciences, The MetroHealth System/Case Western Reserve University, Aleece Caron, PhD, Associate Professor of Medicine, The MetroHealth System/Case Western Reserve University
Principal Investigator: James E. Bailey, MD, MPH, Professor of Medicine and Preventive Medicine, University of Tennessee Health Science Center; Benjamin Heavrin, MD, MBA, Chief Medical Officer, Qsource
Evaluating and Sharing Progress
Demonstrating and spreading what works is at the core of the Building State Capacity initiative. AHRQ will synthesize what is learned about how best to develop State-level QI support capacity, deliver and coordinate external QI support, establish a statewide network of engaged primary care practices, and promote implementation of PCOR evidence using the EvidenceNOW Model.
Throughout the initiative, AHRQ will disseminate interim lessons, resources, tools, and success stories to inform other State-based QI efforts and advance shared, statewide goals for primary care improvement. Look for upcoming resources in the EvidenceNOW Tools for Change section.