EvidenceNow: Advancing Heart Health in Primary Care

September 3, 2015   |  Tags: Blog   |  Tags: Million Hearts , Rural , QI , HIT
Caitlin Dickinson

The U.S. Agency for Healthcare Research and Quality (AHRQ) has made heart health a priority through the campaign EvidenceNOW: Advancing Heart Health in Primary Care. Heart disease is the leading cause of death for men and women in the United States; on an annual basis, Americans suffer over 1.5 million heart attacks and strokes. On May 26, 2015 the U.S. Department of Health and Human Services Secretary, Sylvia M. Burwell, announced awards of $112 million to regional cooperatives to work with about 5,000 primary care professionals in 12 states to improve the heart health of their nearly 8 million patients through the EvidenceNOW campaign. This initiative helps primary care practices in both urban and rural communities use the latest evidence to encourage efforts for Better Care, Smarter Spending, and Healthier People, and the awards are aligned with the Department’s and Million Hearts® national initiative to prevent heart attacks and stroke.

The EvidenceNOW initiative established seven regional cooperatives composed of multidisciplinary teams of experts that provide quality improvement services to up to 300 small primary care practices. These services include onsite coaching, consultation from experts in health care delivery improvement, sharing best practices, and electronic health record support. This initiative helps small primary care practices incorporate the most recent evidence on how best to deliver the ABCs of cardiovascular prevention into their patients’ care:

  • Aspirin use by high-risk individuals,
  • Blood pressure control,
  • Cholesterol management, and
  • Smoking cessation.

The goal of the EvidenceNOW initiative is to give primary care practices the support they need to help patients live healthier and longer, said Secretary Burwell. By targeting smaller practices, we have a unique opportunity to reduce cardiovascular risk factors for hundreds of thousands of patients, and learn what kind of support results in better patient outcomes.

There is a need for building critical infrastructure to help smaller, primary care practices throughout the Pacific Northwest use the latest evidence to improve heart health. The Pacific Northwest has a mix of highly agricultural and sparsely populated counties with a growing Hispanic population and large and growing urban centers. Heart health indicators vary considerably across the region. They are worse in rural counties where primary care has fewer internal quality improvement (QI) resources than in more populated urban areas. For example, heart attack deaths in some rural counties are almost twice as high as in larger metropolitan counties. In addition, mortality rates from stroke are higher in the region than in the United States as a whole.

Achieving better heart health outcomes for patients is an ongoing priority for the Oregon community. As our healthcare environment continues to evolve rapidly, smaller practices face challenges in their ability to effectively use data and improve quality. This is increasingly important for reimbursement eligibility. Many smaller practices lack the internal resources for optimizing health information technology (HIT) and building QI capacity.

Healthy Hearts Northwest: Improving Practice Together (H2N) is part of EvidenceNOW, the AHRQ grant initiative to transform health care delivery. With partners Qualis Health, and the MacColl Center for Health Care Innovation (recipient of the AHRQ funding for this initiative and H2N PI office), the Oregon Rural Practice-based Research Network (ORPRN) at the Oregon Health & Science University (OHSU) will  select 130 small- and medium-sized primary care practices throughout Oregon to participate in H2N. ORPRN seeks to help these practice build their quality improvement (QI) capabilities and infrastructure, and to transform practices into learning organizations that engage in sustained, continuous, systematic QI.   The practices will learn practical strategies that can strengthen their organizations and restore the joy to primary care.  The initial focus of H2N will be implementing Patient-Centered Outcomes Research (PCOR) to improve heart health, as described within the Million Hearts campaign related to ABCS: Aspirin, Blood pressure, Cholesterol and Smoking cessation.

Through EvidenceNOW, ORPRN plans to:
  1. Identify, recruit, and conduct baseline assessments in 130 small- and medium-sized primary care practices across Oregon,
  2. Provide a variety of support tools to build QI capacity within these practices centering on facilitation from an OHSU-based research coordinator and including academic detailing, peer-to-peer learning, and webinars,
  3. Disseminate and support the adoption of PCOR findings relevant to the Million Hearts ABCS quality measures,
  4. Evaluate the effectiveness of providing practice support (item #2 above) to implement PCOR findings and improve ABCS measures, and
  5. Assess the sustainability of changes made in QI capacity and ABCS improvements.

This project is the largest practice change initiative ORPRN has taken on; ORPRN looks forward to begin working with practices in November 2015. Healthy Hearts Northwest is an unprecedented opportunity for primary care to prove to the nation that we can make a difference in cardiovascular health at a scale never before tested, said the principal investigator of Healthy Hearts Northwest, Michael Parchman. Practices that participate will receive resources, support, and a ‘roadmap’ to build their capacity to really do quality improvement well.

 Over the course of 15 months, OPRRN will:
  1. Provide a Practice Enhancement Research Coordinator (PERC) to support improving ABCS heart health measures, including how to use EHRs for QI purposes. The PERC will visit the practice regularly, with monthly calls in between visits, and will be accessible by phone.
  2. Assist with producing reports of ABCS clinical quality measures.
  3. Provide benchmark reports on ABCS clinical quality performance measures to the practice on each measure, with benchmarks at a regional, state, and national level.
  4. Provide high-value information about how to participate in value-based reimbursement programs, such as PQRS and meaningful use.
  5. Provide survey results back to the practice that indicate opportunities for improving QI infrastructure.
  6. Conduct webinars every other month to assist practices with meeting H2N improvement milestones.
  7. Convene phone-based office hours to discuss different topics and share lessons learned.
  8. Support participation in this study as meeting ABFM and ABIM MOC Part IV requirements.
The practice agrees to improve ABCS performance measures and will:
  1. Schedule a two-hour, in-person “Welcome visit” with a PERC.
  2. Complete surveys at 3 time points: upon project enrollment, at the end of the 15 months of practice support, and 6 months after completing 15 months of practice support: This includes a practice or clinic-level survey completed by a practice manager or leader and a survey completed by all clinicians and staff who work in the practice.
  3. Designate a “Healthy Hearts Champion”, usually a physician or non-physician (nurse practitioner or physician assistant) clinician and a point of contact for the H2N project team.
  4. Convene a Healthy Hearts Improvement Team of at least three individuals comprising the Healthy Hearts Champion and a representative from the front and back office.
  5. Provide protected time for the Healthy Hearts Improvement Team to meet internally weekly to develop and work on improvement milestones and conduct small cycle tests of change to improve ABCS heart health measures.
  6. In addition to the internal Improvement Team meeting, at least two members of the Improvement Team will participate in face-to-face visits or a monthly phone call with the PERC, attend a Healthy Hearts Webinar with all practices across the 3 states for one hour every other month and participate in phone-based office hours.
  7. Collect and provide the study team with aggregate practice-level data (unique to each practice location) on clinical quality measures related to aspirin use, blood pressure control, cholesterol control, and smoking cessation (ABCS) quarterly from enrollment until April 30, 2018.
Who Do I Contact if I am Interested, or Know of Potential Practices?

Please contact ORPRN’s H2N project manager, Caitlin Dickinson, at summerca@ohsu.edu or 503-494-9106. More information about H2N is available at http://www.ohsu.edu/xd/outreach/oregon-rural-practice-based-research-network/.

Caitlin Dickinson serves as project manager for ORPRN’s Healthy Hearts Northwest (H2N) R18 project. Prior to joining ORPRN, she worked for OHSU’s department of OB/GYN and coordinated career development (K12) programs and research projects focused on evidence-based medicine, comparative effectiveness, patient safety, and improving teamwork and leadership among healthcare personnel.

Caitlin grew up in the Portland area. She holds a Bachelor’s degree in biology and chemistry from the University of Denver and a Master of Public Health degree from Oregon State University. In her leisure time, she enjoys cycling, swimming, reading, and relaxing with her family.