AHRQ Views: Blog posts from AHRQ leaders
Research from AHRQ’s EvidenceNOW Initiative Sets the Stage for Advances in Primary Care
Three years ago, AHRQ embarked on a pioneering journey to learn about and, more importantly, to support transformation in primary care. AHRQ harnessed everything it had learned from 10 years of research investments and funded eight grantees to launch its largest-ever study of primary care—EvidenceNOW: Advancing Heart Health in Primary Care.
Our objective was to accelerate the dissemination and implementation of patient-centered outcomes research findings by increasing the capacity of primary care practices to find and use the best evidence for care. Our approach was focused on decreasing the risk of heart disease and helping prevent heart attacks and strokes by increasing the delivery of the evidence-based “ABCS” of heart health—Aspirin use by high-risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation.
Since the project’s inception, seven of the grantees, known as cooperatives, are working to increase the delivery of these interventions. All told, the cooperatives have supported more than 1,500 small and medium-sized primary care practices and more than 5,000 primary care clinicians serving over 8 million patients in 12 States.
We’ve learned a tremendous amount from this investment. Research from the initiative has been presented at dozens of professional meetings and published in another dozen journal articles. Findings have also been shared through blog posts and webinars, as well as practice stories and infographics featured on the EvidenceNOW web pages.
With a fresh set of publications this month, however, we’ve reached a notable milestone in our efforts to share results and insights from EvidenceNOW with health care decisionmakers, health care systems, primary care professionals, and the public. A new Annals of Family Medicine supplement—"AHRQ’s EvidenceNOW: Early Findings"—highlights grantee research efforts that identify important opportunities and challenges in the primary care environment:
“AHRQ’s EvidenceNOW: Early Findings.”
- The New York City Cooperative found high rates of ABCS delivery in its small, solo community practices.
- The Northwest and Midwest Cooperatives noted the importance of relationship building to recruiting practices for quality improvement (QI) initiatives.
- The Southwest Cooperative highlighted the value of patient and community input for tailoring heart disease prevention materials.
- The Virginia Cooperative found that clinic staff—not just clinicians—are critical to creating positive perceptions of the practice work environment, psychological safety, and lower staff burnout.
- The Midwest Cooperative found targeted efforts to facilitate changes in primary care are better received than large-scale QI programs.
- The Oklahoma Cooperative described the alarming rate of major disruptive events in primary care. Their observations may uncover solutions by practices that have successfully managed such events.
- EvidenceNOW’s national evaluation team found practices most likely to use QI strategies are those that participated in accountable care organizations, produced reports from electronic health records, produced quality reports, or discussed clinical quality data in meetings.
- The two outstanding commentaries suggested paths forward regarding approaches to financing and QI in primary care.
As we note the importance of these specific findings from the supplement, we’ve also been able to recognize broader themes that have emerged since the EvidenceNOW project began. We understand, for example, that financial uncertainties have resulted in significant practice consolidations and closures, trends that in some cases have tested the capacity of practices to focus on improvement efforts.
The project has also shown the challenges of advancing evidence into practice. The release of new cholesterol guidelines in 2013 and competing sets of guidelines for blood pressure control in 2014 demonstrated the lag times in the evidence pipeline as information moves from updated clinical guidelines to quality measure development to implementation in electronic health records.
In addition, the cooperatives’ work has affirmed that primary care clinicians often face significant obstacles when attempting to record data from patient encounters as well as obtain data from electronic health records. While success stories can be found, the promise of health information technology (IT) in primary care seems largely unrealized.
The good news is that the EvidenceNOW cooperatives are helping practices build capacity to function more effectively and efficiently in a dynamic health care environment, develop resources to practice evidence-based medicine even when the evidence is evolving, and harness health IT for the benefit of patients and clinicians.
Using what we are learning from this work, AHRQ is developing a blueprint for primary care transformation to help guide others who want to engage in supporting primary care. We hope you’ll stay tuned as the EvidenceNOW journey continues. AHRQ and its grantees are committed to sharing new insights as soon as they are available.
Bob McNellis is the AHRQ Senior Advisor for Primary Care.