EvidenceNOW: Advancing Heart Health in Primary Care

April 20, 2018, 08:42 am Sheri Porter – The March/April issue of Annals of Family Medicine includes a special supplement that has a collection of original research articles with early findings from a massive research project launched by the Agency for Healthcare Research and Quality in May 2015.

That grant initiative -- dubbed EvidenceNOW: Advancing Heart Health in Primary Care -- was created to help small- and medium-size primary care offices around the country implement best practices related to the four "ABCS" of cardiovascular disease prevention:

• aspirin use by high-risk individuals,
  
• blood pressure control,
  
• cholesterol management and
  
• smoking cessation.

The EvidenceNOW initiative aligns with HHS' 2012 Million Hearts campaign -- now in the final year of a five-year commitment -- which is aimed at preventing one million heart attacks and strokes by encouraging people to make healthy choices.

In an interview with AAFP News, family physician and AHRQ Chief Medical Officer David Meyers, M.D., said EvidenceNOW is the largest study of primary care ever conducted by the agency -- and potentially one of the largest ever done in the United States, with more than 1,500 practices participating.

This initiative is about learning how to provide meaningful practice support in quality improvement (QI) to smaller primary care practices that often don't have the internal resources that large practices and health systems do, said Meyers.

The initiative, funded with grants totaling $112 million, established seven regional cooperatives across multiple states, and involves nearly 8 million patients.

"If we're successful, hundreds of thousands of Americans will have their blood pressure under control, their cholesterol under control, and have their risks reduced for having a heart attack or stroke," said Meyers.

The supplement includes eight articles that detail specific areas of research. Authors reported that

• solo primary care practices in New York City are more likely than group practices to meet the ABCS targets for reducing cardiovascular risk;
  
• recruiting practices for large-scale practice QI transformation initiatives are difficult and costly;
  
• hospital ownership of a practice is associated with positive perceptions of work environment and lower rates of burnout among staff members;
  
• major disruptions are frequent in primary care and adversely affect QI efforts;
  
• wide variation exists in the use of QI strategies among small- and medium-size primary care practices in 12 states, and practices likely need external support to prepare for new payment and delivery models;
  
• primary care leadership and practice adaptive reserve are not associated with achieving baseline blood pressure control among patients;
  
• interventions created to aid primary care practices in lowering cardiovascular disease risk in culturally different communities are not one-size-fits-all; and
  
• greater opportunities may exist to help small practices with QI efforts through simple, targeted practice facilitator support work rather than through big comprehensive projects.

And for the research wonks who really like to dig deep into details and analyses, the supplement also provides a couple of project overviews -- one authored by Meyers -- and two editorials, one titled "Technical Assistance for Primary Care Practice Transformation: Free Help to Perform Unpaid Labor?" and the other titled "Finding a Parsimonious Path for Primary Care Practice Transformation."

Why should family physicians care about this initiative when for years the country's health care system has been awash in QI pilot projects attempting to help primary care practices move toward value-based care?

Picture a large scaffolding surrounding a practice that helps it succeed. That's how Meyers envisions EvidenceNOW.

"With this project, we are building a blueprint for the nation about to how to support primary care practices," said Meyers.

AHRQ knows that too many small practices are wondering if they can make it in the future. Those practices are doing good work in their communities, and they are so responsive to the needs of their patients.

"There's real joy in practice out there, but all this other 'stuff' has the potential to take that away," said Meyers. "This project has real potential to lower the burden on family physicians so they are able to make that transition."

When all is said and done, findings from this initiative should lead to external support that really works for family physicians. And those external resources will be designed and offered by entities with the deep pockets to do so -- think private insurers, large health systems and government-supported QI organizations.

Meyers urged his family physician colleagues to continue to follow the progress of EvidenceNOW.

"This project is an example of why research matters," he said. "It's not just about partnering with these 1,500-plus primary care practices to help them deliver better care today. We are learning how to take this to a national level so that it will benefit practices in the future."

More From AAFP
Basics of Quality Improvement

Additional Resource
HHS Million Hearts campaign