National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 87 Research Studies DisplayedKrefman AE, Ciolino Jd, Kan AK
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
The objective of the Healthy Hearts for Michigan (HH4M) study is to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts. This three-year research program evaluates rural and medically underserved primary care practices’ ability to implement the quality improvement model and tests whether the model improves blood pressure control and tobacco use screening and cessation. Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M. HH4M is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery.
AHRQ-funded; HS027954.
Citation: Krefman AE, Ciolino Jd, Kan AK .
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
Contemp Clin Trials Commun 2023 Oct; 35:101199. doi: 10.1016/j.conctc.2023.101199..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
McHugh M, Heinrich J, Philbin S
Declining participation in primary care quality improvement research: a qualitative study.
This qualitative study’s aim was to identify factors leading primary care practices to decline participation in quality initiative (QI) projects, and strategies to improve the feasibility and attractiveness of QI projects in the future. The authors contacted 109 representatives of practices that had declined participation in 1 of 4 AHRQ-funded EvidenceNOW projects. The representatives were invited to either participate in a 15-minute interview or complete a 5-question questionnaire. Representatives from 31 practices responded. Reasons for declining included staff turnover, staffing shortages, and general time constraints, exacerbated by the pandemic, preventing participation in the QI projects. Secondary reasons included challenges with electronic health records, an expectation of greater financial compensation for participation, and confidence in the practices' current care practices. Tying participation to value-based programs and offering greater compensation were identified as strategies to facilitate recruitment. However, none of the respondents’ recommendations addressed the primary issues of staffing challenges and time constraints.
AHRQ-funded; HS027954.
Citation: McHugh M, Heinrich J, Philbin S .
Declining participation in primary care quality improvement research: a qualitative study.
Ann Fam Med 2023 Sep-Oct; 21(5):388-94. doi: 10.1370/afm.3007..
Keywords: Quality Improvement, Primary Care, Quality of Care, Practice Improvement, Organizational Change, Evidence-Based Practice
Roberts MM, Marino M, Wells R
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
The objective of this cross-sectional study was to evaluate the association between population-based clinical decision support (CDS) tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices. Researchers used practice-level data from the EvidenceNOW initiative, from practices that submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex. Their findings suggested that practices using CDS tools had small disparities but were not statistically significant; however, CDS tools were not associated with reductions in disparities. They concluded that more research was needed on effective practice-level interventions to mitigate disparities.
AHRQ-funded; HS023940.
Citation: Roberts MM, Marino M, Wells R .
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
JAMA Netw Open 2023 Aug; 6(8):e2326905. doi: 10.1001/jamanetworkopen.2023.26905..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Cardiovascular Conditions, Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care, Evidence-Based Practice, Prevention
Lindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
AHRQ-funded; HS023940.
Citation: Lindner SR, Balasubramanian B, Marino M .
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
McHugh M, Philbin S, Carroll AJ
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
This study’s goal was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. A 49-item survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research was developed. All 44 members of the HH4M Cooperative (79.5% response rate) were surveyed, interviews conducted with 14 members. Having a clear purpose and trust and respect among members were the strengths reported. A need for common terminology, clarification of roles and functions, and improvement in communication across workgroups were areas for improvement. The Cooperative’s biggest challenge was the lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic.
AHRQ-funded; HS027954.
Citation: McHugh M, Philbin S, Carroll AJ .
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
Jt Comm J Qual Patient Saf 2023 Apr;49(4):199-206. doi: 10.1016/j.jcjq.2023.01.002.
Keywords: Quality Improvement, Evidence-Based Practice, Primary Care, Quality of Care, Patient-Centered Outcomes Research
Sirkin JT, Flanagan E, Tong ST
AHRQ Author: Tong ST, McNellis RJ, Bierman AS
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
The purpose of this paper was to review the Agency for Healthcare Research and Quality’s (AHRQ) learning community organized to engage and support primary care in responding to COVID-19 and provide an opportunity for participants to communicate learning and peer support, improve understanding of the stressors and challenges faced by practices, determine needs, and identify possible solutions to challenges of the pandemic. The researchers identified challenges, responses, and innovations that occurred through the engagement and information sharing of the learning community and categorized them across 5 domains, including: patient-centeredness, clinician and practice, systems and infrastructure, community and public health; and health equity which cut across each of the other domains. The authors concluded that the learning community provided valuable insights for future research and policy, primary care delivery improvement, and ensuring greater preparedness for future challenges.
AHRQ-authored.
Citation: Sirkin JT, Flanagan E, Tong ST .
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
Ann Fam Med 2023 Jan-Feb; 21(1):76-82. doi: 10.1370/afm.2904..
Keywords: COVID-19, Primary Care, Learning Health Systems, Health Systems, Evidence-Based Practice, Public Health
Viswanathan M, Wallace IF, Cook Middleton J
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors sought to review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force. They found indirect evidence that suggested some screening instruments were reasonably accurate for detecting depression. Further, psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 18;328(15):1543-56. doi: 10.1001/jama.2022.16310..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Depression, Behavioral Health, Screening, Primary Care, Guidelines, Evidence-Based Practice, Prevention
Kuzel AJ, Cuellar A, Nichols L
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
The purpose of this study was for The Heart of Virginia Health care (HVH) collaborative (one of the Agency for Healthcare Research and Quality's (AHRQ) Evidence Now project’s 7 collaboratives) to test different ways to improve performance and outcomes on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) within small primary care practices. The researchers recruited 264 eligible practices and randomized them to 3 cohorts in a stepped wedge design, with 173, utilizing 16 different EHRs, participated through the entire initiative. Trained coaches delivered the practice support curriculum to improve performance on the ABCS measures. The program included an initial kickoff meeting, 3 months of focused support, 9 months of continued support, and access to online materials and faculty. The intervention phase was shortened due to difficulty in recruiting a sufficient number of practices. The study found that the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other anti-thrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. The researchers concluded that the truncation of the intervention contributed to the lack of substantial improvements in the ABCS.
AHRQ-funded; HS023913.
Citation: Kuzel AJ, Cuellar A, Nichols L .
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
J Am Board Fam Med 2022 Oct 18;35(5):979-89. doi: 10.3122/jabfm.2022.05.210021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Primary Care, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Healthcare Delivery
Viswanathan M, Wallace IF, Cook Middleton J
Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to review the evidence on screening for anxiety in children and adolescents to inform the US Preventive Services Task Force. Indirect evidence of findings suggested that some screening instruments were reasonably accurate. Cognitive behavioral therapy and pharmacotherapy were associated with benefits; no statistically significant association with harms was reported.
AHRQ-funded; 290201500011I, 75Q80120D00007.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 11;328(14):1445-55. doi: 10.1001/jama.2022.16303..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Anxiety, Behavioral Health, Primary Care, Screening, Guidelines, Evidence-Based Practice, Prevention
Kowitt SD, Goldstein AO, Cykert S
A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices.
This study investigated the outcomes of an evidence-based cardiovascular disease risk reduction tool called Heart Health Now to improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. This tool was developed as part of AHRQ’s EvidenceNow initiative. This stepped wedge, stratified, cluster randomized trial looked at 28 practices that were staffed by 10 or fewer clinicians and had an electronic health record. Heart Health Now consisted of education tools, onsite practice facilitation for a year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. The practices included in their analyses consisted of 78,120 patients, and 17,687 smokers. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2%. Cessation support rates also significantly increased from 44.3% to 50.1%. Some of the practices associated with improvement included being in an academic health center or faculty, having more clinicians, and having a lower percentage of White patients.
AHRQ-funded; HS023912.
Citation: Kowitt SD, Goldstein AO, Cykert S .
A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices.
J Prev 2022 Jun;43(3):375-86. doi: 10.1007/s10935-022-00672-5..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Screening, Primary Care, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions
Richardson JE, Rasmussen LV, Dorr DA
Generating and reporting electronic clinical quality measures from electronic health records: strategies from EvidenceNOW cooperatives.
This study’s goal was to characterize strategies that seven regional cooperatives participating in the EvidenceNOW initiative developed to generate and report electronic health record (EHR)-based electronic clinical quality measures (eCQMs) for quality improvement (QI) in small-to-medium-sized practices. Findings showed that cooperatives ultimately generated and reported eCQMs using hybrid strategies because they determined that neither EHRs alone nor centralized sources alone could operationalize eCQMs for QI. In order to attain this goal, cooperatives needed to devise solutions and utilize resources that often are unavailable to typical small-to-medium-sized practices.
AHRQ-funded; HS023921.
Citation: Richardson JE, Rasmussen LV, Dorr DA .
Generating and reporting electronic clinical quality measures from electronic health records: strategies from EvidenceNOW cooperatives.
Appl Clin Inform 2022 Mar;13(2):485-94. doi: 10.1055/s-0042-1748145..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Quality of Care, Evidence-Based Practice, Primary Care
Bierman AS, Tong ST, McNellis RJ
AHRQ Author: Bierman AS, Tong ST, McNellis RJ
Realizing the dream: the future of primary care research.
In this article, the authors discussed the primary care research central to successful primary care transformation and to realizing the vision of a high-performing US health system to serve effectively all Americans and their communities while advancing health equity.
AHRQ-authored.
Citation: Bierman AS, Tong ST, McNellis RJ .
Realizing the dream: the future of primary care research.
Ann Fam Med 2022 Mar-Apr;20(2):170-74. doi: 10.1370/afm.2788..
Keywords: Primary Care, Healthcare Delivery, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Healthcare
Hysong Hysong, Arredondo K, Hughes AM
An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.
The purpose of this article was to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and generate new measures of health care quality, using primary care as a case example. Subject matter experts identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The authors indicated that their article provides an actionable guide to applying their Productivity Measurement and Enhancement System, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures.
Citation: Hysong Hysong, Arredondo K, Hughes AM .
An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.
PLoS One 2022 Jan 18;17(1):e0261263. doi: 10.1371/journal.pone.0261263..
Keywords: Primary Care, Evidence-Based Practice, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care
Ibemere SO, Tanabe P, Bonnabeau E
Awareness and use of the sickle cell disease toolbox by primary care providers in North Carolina.
The authors developed a decision support tool for sickle cell disease (SCD) for SCD management (SCD Toolbox) based on the National Heart, Lung, and Blood Institute's SCD guidelines. Using data from primary care providers (PCPs) in North Carolina, they found that PCPs rarely co-managed with a specialist, had low awareness and use of the SCD Toolbox, and requested multiple formats for the toolbox.
AHRQ-funded; HS024501.
Citation: Ibemere SO, Tanabe P, Bonnabeau E .
Awareness and use of the sickle cell disease toolbox by primary care providers in North Carolina.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211049050. doi: 10.1177/21501327211049050..
Keywords: Sickle Cell Disease, Primary Care, Chronic Conditions, Shared Decision Making, Evidence-Based Practice
Davidson KW, Krist AH, Tseng CW
AHRQ Author: Mills J, Borsky A
Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care.
The authors assessed how social risks have been considered in USPSTF recommendation statements and identified current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations. They concluded that their report serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated into USPSTF methods and recommendations.
AHRQ-authored.
Citation: Davidson KW, Krist AH, Tseng CW .
Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care.
JAMA 2021 Oct 12;326(14):1410-15. doi: 10.1001/jama.2021.12833..
Keywords: U.S. Preventive Services Task Force (USPSTF), Primary Care, Social Determinants of Health, Risk, Evidence-Based Practice, Research Methodologies, Guidelines
Bierman AS, Wang J, O'Malley PG
AHRQ Author: Bierman AS, Wang J, O'Malley PG, Moss DK
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation: Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords: Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Berry CA, Nguyen AM, Cuthel AM
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
This study measured implementation strategy fidelity for the HealthyHearts NYC intervention program, an AHRQ-funded program that uses practice facilitation (PF) to improve adoption of cardiovascular disease evidence-based guidelines in primary care practices. Data from 257 practices measured fidelity using 4 categories: frequency, duration, content, and coverage. Almost all (94.2%) of practices received at least the 13 PF visits with an average 26.3 hours spent at each site by facilitators. Most practices (95.7%) completed all Task List items, and 71.2% were educated on all Chronic Care Models, with the majority (65.8%) receiving full coverage.
AHRQ-funded; HS023922.
Citation: Berry CA, Nguyen AM, Cuthel AM .
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
Am J Med Qual 2021 Jul-Aug;36(4):270-76. doi: 10.1177/1062860620959450..
Keywords: Implementation, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Practice Improvement, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care: Models of Care
Pham-Singer H, Onakomaiya M, Cuthel A
Using a customer relationship management system to manage a quality improvement intervention.
HealthyHearts New York City (HHNYC), one of 7 cooperatives funded through the Agency for Healthcare Research and Quality's EvidenceNOW initiative, evaluated the impact of practice facilitation on implementation of the Million Hearts guidelines for cardiovascular disease prevention and treatment. Tracking the intervention required a system to facilitate process data collection that was also user-friendly and flexible. Coupled with protocols and training, a strategically planned and customizable customer relationship management system (CRMS) was implemented to support the quality improvement intervention with 257 small independent practices.
AHRQ-funded; HS023922.
Citation: Pham-Singer H, Onakomaiya M, Cuthel A .
Using a customer relationship management system to manage a quality improvement intervention.
Am J Med Qual 2021 Jul-Aug;36(4):247-54. doi: 10.1177/1062860620953214..
Keywords: Quality Improvement, Quality of Care, Implementation, Evidence-Based Practice, Cardiovascular Conditions, Heart Disease and Health, Primary Care
Cohen DJ, Sweeney SM, Miller WL
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
This study identified conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care using samples and interviews from a subset of 104 practices participating in EvidenceNOW, a multisite cardiovascular disease prevention initiative. The authors calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening, and if relevant, counseling and the proportion of hypertensive patients with adequately controlled BP. Primary care staff were surveyed and interviewed. In clinician-owned practices, implementing a workflow to routinely screen and counsel patients on smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome. These improvements did not occur though in health- or hospital system-owned practices or in Federally Qualified Health Centers. BP outcome improved by at least 10 points among solo practices after medical assistants learned how to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improvement took place when staff took a second BP measurement after the first measurement was elevated and when staff learned where to document this information in the electronic health record. For larger and health- and hospital system-owned practices, 50 or more hours of facilitation was needed to improve BP outcomes.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Sweeney SM, Miller WL .
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
Ann Fam Med 2021 May-Jun;19(3):240-48. doi: 10.1370/afm.2668..
Keywords: Blood Pressure, Tobacco Use, Primary Care, Quality Improvement, Cardiovascular Conditions, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention, Outcomes
Tanabe P, Blewer AL, Bonnabeau E
Dissemination of evidence-based recommendations for sickle cell disease to primary care and emergency department providers in North Carolina: a cost benefit analysis.
Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. The authors report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). They report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit.
AHRQ-funded; HS024501.
Citation: Tanabe P, Blewer AL, Bonnabeau E .
Dissemination of evidence-based recommendations for sickle cell disease to primary care and emergency department providers in North Carolina: a cost benefit analysis.
J Health Econ Outcomes Res 2021 Apr 1;8(1):18-28. doi: 10.36469/jheor.2021.21535..
Keywords: Sickle Cell Disease, Evidence-Based Practice, Guidelines, Primary Care, Emergency Department, Tools & Toolkits
Gold HT, Siman N, Cuthel AM
A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: a cost analysis.
In this randomized controlled trial, researchers estimated the associated cost of practice facilitation (PF) for guideline adoption in small, private primary care practices. They found that the PF strategy cost approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. They indicated that whether or not this program is worthwhile to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction.
AHRQ-funded; HS023922.
Citation: Gold HT, Siman N, Cuthel AM .
A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: a cost analysis.
Implement Sci Commun 2021 Feb 6;2(1):15. doi: 10.1186/s43058-021-00116-x..
Keywords: Primary Care, Cardiovascular Conditions, Guidelines, Prevention, Evidence-Based Practice, Primary Care: Models of Care, Healthcare Costs
Tuzzio L, O'Meara ES, Holden E
Barriers to implementing cardiovascular risk calculation in primary care: alignment with the consolidated framework for implementation research.
The uptake of cardiovascular disease risk calculators in primary care has been slow despite the recommendation in national cardiovascular disease prevention guidelines. Identifying the barriers to the implementation of cardiovascular disease risk calculators is essential for promoting their adoption. In this study, the authors qualitatively analyzed structured physician educator notes written during an outreach education intervention with 44 small- and medium-sized primary care clinics that participated in the Agency for Healthcare Research and Quality‒funded EvidenceNOW Healthy Hearts Northwest trial.
AHRQ-funded; HS023908.
Citation: Tuzzio L, O'Meara ES, Holden E .
Barriers to implementing cardiovascular risk calculation in primary care: alignment with the consolidated framework for implementation research.
Am J Prev Med 2021 Feb;60(2):250-57. doi: 10.1016/j.amepre.2020.07.027..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Primary Care, Risk, Evidence-Based Practice, Implementation
Solberg LI, Kuzel A, Parchman ML
A taxonomy for external support for practice transformation.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. In this study, the researchers’goal was to develop a taxonomy that could be used by both external groups or researchers and health care leaders. The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention.
AHRQ-funded; HS023940.
Citation: Solberg LI, Kuzel A, Parchman ML .
A taxonomy for external support for practice transformation.
J Am Board Fam Med 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225..
Keywords: Primary Care, Healthcare Delivery, Cardiovascular Conditions, Evidence-Based Practice, Prevention, Quality Improvement, Practice Improvement, Quality of Care
Cykert S, Keyserling TC, Pignone M
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Researchers assessed the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. They found that a risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year atherosclerotic cardiovascular disease risk for patients at high risk. They recommended utilizing similar approaches to lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices.
AHRQ-funded; HS023912.
Citation: Cykert S, Keyserling TC, Pignone M .
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Health Serv Res 2020 Dec;55(6):944-53. doi: 10.1111/1475-6773.13571..
Keywords: Cardiovascular Conditions, Risk, Prevention, Primary Care, Implementation, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Nguyen AM, Cuthel AM, Rogers ES
Attributes of high-performing small practices in a guideline implementation: a multiple-case study.
This study called HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation in small primary care practices in adopting cardiovascular disease guidelines. The practice-level benchmark desired was having 70% or greater of hypertensive patients having controlled blood pressure. A mixed methods multiple-case study design was used and implemented at 6 small practices. The investigator’s first key finding was that the high-performing and improved practices in their study looked and acted similarly during the intervention implementation. Three key attributes of these practices were found to be: 1) advanced use of electronic health records; 2) dedicated resources and commitment to quality improvement; and 3) an actively engaged lead clinician and office manager.
AHRQ-funded; HS023922.
Citation: Nguyen AM, Cuthel AM, Rogers ES .
Attributes of high-performing small practices in a guideline implementation: a multiple-case study.
J Prim Care Community Health 2020 Jan-Dec;11. doi: 10.1177/2150132720984411..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Guidelines, Implementation