The EvidenceNOW Practice Support Initiative: The Heart of Virginia Healthcare.

Area of Science:

• Primary care quality improvement
• Health services research
• Clinical quality measures

Background:

• The Million Hearts campaign targets ABCS (Aspirin use, Blood pressure control, Cholesterol control, Smoking cessation).
• The Evidence Now project explored methods to enhance ABCS performance in primary care.
• The Heart of Virginia Health care (HVH) collaborative developed a specific intervention approach.

Purpose of the Study:

• To evaluate the impact of the HVH intervention on ABCS clinical quality measures in primary care practices.
• To assess the effectiveness of a practice support curriculum delivered by coaches.

Main Methods:

• A stepped wedge design randomized 264 practices into 3 cohorts.
• 173 practices completed the initiative, utilizing 16 different EHR systems.
• The intervention included a kickoff meeting, 3 months intensive support, 9 months ongoing support, and online resources.

Main Results:

• A small, statistically significant positive effect was observed for appropriate aspirin use.
• Small negative effects were noted for blood pressure control and smoking cessation counseling.
• Practice contact time with coaches varied significantly (mean 428 minutes, SD 426 minutes).

Conclusions:

• The truncated intervention phase and recruitment difficulties limited substantial ABCS improvements.
• Lack of real-time feedback and practice disruptions were contributing factors.
• Future interventions require adequate time for recruitment and support delivery.