Advancing heart health in North Carolina primary care: the Heart Health NOW study protocol

Abstract

BackgroundThe objective of Heart Health NOW (HHN) is to determine if primary care practice support—a comprehensive evidence-based quality improvement strategy involving practice facilitation, academic detailing, technology support, and regional learning collaboratives—accelerates widespread dissemination and implementation of evidence-based guidelines for cardiovascular disease (CVD) prevention in small- to medium-sized primary care practices and, additionally, increases practices’ capacity to incorporate other evidence-based clinical guidelines in the future.Methods/designHHN is a stepped wedge, stratified, cluster randomized trial to evaluate the effect of primary care practice support on evidence-based CVD prevention, organizational change process measures, and patient outcomes. Each practice will start the trial as a control, receive the intervention at a randomized time point, and then enter a maintenance period 12 months after the start of the intervention. The intervention will be randomized to practices in one of four strata defined by region of the state (east or west) and degree of practice readiness for change. Seventy-five practices in each region with a high degree of readiness will be randomized 1:1:1 in blocks of 3 sometime prior to month 8 to receive the intervention at month 9, 11, or 12. An additional 75 practices within each region that have a low degree of readiness or are recruited later will be randomized 1:1 in blocks of 2 prior to month 13 to receive the intervention at month 14 or 16. The sites will be ordered within each strata based on time of enrollment with the blocking based on this ordering. Evaluation will examine the effect of primary care practice support on (1) practice-level delivery of evidence-based CVD prevention, (2) patient-level health outcomes, (3) practice-level implementation of clinical and organizational changes that support delivery of evidence-based CVD prevention, and (4) practice-level capacity to implement future evidence-based clinical guidelines.DiscussionResults will indicate whether primary care practice support is an effective strategy for widespread dissemination and implementation of evidence-based clinical guidelines in primary care practices. Discernible reductions in cardiovascular risk in 300 practices covering over an estimated 900,000 adult patients would likely lead to prevention of thousands of cardiovascular events within 10 years.Trial registrationClinicalTrials.gov NCT02585557Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0348-4) contains supplementary material, which is available to authorized users.

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

“…The 7 participating regions that cover 12 US states include Colorado and New Mexico (Southwest Region); Illinois, Wisconsin, and Indiana (Midwest Region); New York City; North Carolina; Oklahoma; Virginia; and Washington, Oregon, and Idaho (Northwest Region). [36][37][38] AHRQ also funded an independent national evaluation of the overall initiative-ESCA-LATES (Evaluating System Change to Advance Learning and Take Evidence to Scale).…”

Recruiting Practices for Change Initiatives Is Hard: Findings From EvidenceNOW

“…EvidenceNOW is an AHRQ-funded initiative that aims to help primary care practices improve patient heart health through the adoption of the evidence-based ABCS of cardiovascular disease prevention: aspirin in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation. 2 AHRQ funded seven Cooperatives that cover geographically dispersed regions (single state or contiguous states) involving 12 states [22][23][24] and an independent National Evaluation called Evaluating System Change to Advance Learning And Take Evidence to Scale (ESCALATES) to inform large-scale dissemination and implementation of evidence. 3,25 Each Cooperative designed its own intervention focused on helping primary care practices implement evidence-based guidelines for cardiovascular preventive care targeted to patients at risk for cardiovascular disease.…”

Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review

“…In 2015, AHRQ also launched the EvidenceNOW consortium, a national initiative to test whether on-site practice facilitation and coaching improve heart health, specifically the BABCS^(aspirin use by high-risk individuals, blood pressure control, cholesterol management, and smoking cessation), within the primary care setting. [8][9][10][11] With the growth and development of practice facilitation across North America, prior literature reviews on this subject were limited to studying the overall effect on process improvement and patient outcomes or were limited to reporting changes in practice processes, but lacked results in chronic disease measures. 12,13 The purpose of this systematic review is to summarize the evidence on the effect of practice facilitation in primary care settings on chronic disease processes and outcomes for patients with the most prevalent chronic conditions.…”