AHRQ’s Research and Tools Help Transform Delivery of Primary Care

The unprecedented challenges of COVID-19 underscored the vital role played by the Nation’s vast network of primary care practices—and also their vulnerabilities. The pandemic showed us that renewed attention must be paid not only to delivering high-quality care, but also to supporting the well-being of primary care clinicians and staff.

Even before the pandemic, primary care practices were struggling with a healthcare landscape of practice disruptions, staff turnover and burnout, and other barriers to providing the highest quality care. Despite these challenges, the Agency’s EvidenceNOW: Advancing Heart Health initiative provided a model of how to help primary care practices deliver better care. This 5-year project, completed just prior to the COVID-19 pandemic, tested whether practice facilitation and other quality improvement services can help small- and medium-sized primary care practices implement the latest evidence to improve patients’ heart health.

An independent evaluation, whose findings have been published in an article by Dr. Deborah Cohen and others, revealed that, overall, primary care practices participating in EvidenceNOW improved the delivery of heart healthcare in four important areas:

• Counseling on aspirin use among high-risk patients increased 3.3 percent.
• Blood pressure control rose 1.6 percent, despite a national decline in blood pressure control over this same period.
• Cholesterol management increased 4.4 percent.
• Screening, counseling, and medication for smoking cessation jumped 7.3 percent.

These improvements may appear modest. But given the scope of the initiative—we enlisted 1,500 small- to medium-sized primary care practices in 12 States, reaching approximately 5,000 primary care providers and 8 million patients—the impact was significant.

As one example, support provided to mostly small, rural practices in North Carolina reduced 10-year cardiovascular risk for patients at high risk of a stroke or heart attack by using a risk-stratified, population management dashboard and practice facilitation support. The researchers estimated that this intervention at 219 practices will prevent 5,800 cardiovascular events over the next 10 years, with $11,000 avoided expense per prevented event—a cost savings of $63.8 million.

EvidenceNOW also provided several insights on whether small- to medium-sized primary care practices would accept a model of external support, and whether that support would help change how they delivered care. In a recent blog post in Health Affairs, Dr. Cohen and Dr. Shannon Sweeney suggested that a feasible national infrastructure based on the EvidenceNOW model could help primary care practices tackle current and future challenges, including COVID-19.

EvidenceNOW is just one model. However, it exemplifies AHRQ’s decades-long commitment to transform the delivery of primary care and support providers’ efforts to use the latest evidence in clinical practice.

Lessons learned from the project have already been put to use. AHRQ is applying the model to better understand different aspects of primary care delivery: how to integrate behavioral health in primary care to manage unhealthy alcohol use in adults; how to enhance the linkages between primary care, community-based organizations, and specialty care to manage urinary incontinence in women; and how to build State-based infrastructures to support primary care to enhance equity in heart healthcare. You can find out more about these initiatives here.

We’ve made it a priority to share our findings and lessons learned and to create, curate, and publicly share all the tools and training materials developed as part of EvidenceNOW. EvidenceNOW Tools for Change is a collection of over 100 tools for primary care practices, practice facilitators, and others to build capacity for quality improvement.

These tools—as well as others available at AHRQ’s National Center for Excellence in Primary Care Research and the Academy for Integrating Behavioral Health and Primary Care—are crucial to the Agency’s mission and represent the fruits of our efforts to help primary care professionals deliver the best possible care for their patients.

At AHRQ we remain committed to learning how best to support primary care practices in delivering high-quality, equitable primary care, while continuing to support the well-being and resilience of primary care clinical teams.

Dr. Miller is Acting Director of AHRQ’s Center for Evidence and Practice Improvement.

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