The EvidenceNOW Practice Support Initiative: The Heart of Virginia Healthcare

HHS' Million Hearts campaign focused the delivery system on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling). AHRQ's Evidence Now project funded 7 collaboratives to test different ways to improve performance and outcomes on ABCS within small primary care practices. The Heart of Virginia Health care (HVH) collaborative designed 1 of the approaches in Evidence Now.

Two hundred sixty-four eligible practices were recruited to participate and randomized to 3 cohorts in a stepped wedge design, and 173, employing 16 different EHRs, remained for the duration of the initiative. The practice support curriculum was delivered by trained practice coaches to enhance overall practice function and improve performance on the ABCS metrics. The intervention consisted of a kickoff meeting, 3 months of intensive support, 9 months of ongoing support, and access to online learning materials and expert faculty. The mean practice contact time with coaches was 428 minutes, but the standard deviation was 426 minutes.

Overall, the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other antithrombotics, 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 intervention phase was truncated due to difficulty in recruiting a sufficient number of practices. This undoubtedly contributed to the lack of substantial improvements in the ABCS. Other likely contributing factors were our inability to provide real time feedback on metrics and the frequency with which major practice disruptions occurred. Future efforts to improve primary care practice function should allow adequate time for both practice recruitment and external support.