Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW)

Abstract

Purpose: To improve cardiovascular care through supporting primary care practices' adoption of evidence-based guidelines. Study Design: A cluster randomized trial compared two approaches: (1) standard practice support (practice facilitation, practice assessment with feedback, health information technology assistance, and collaborative learning sessions) and (2) standard support plus patient engagement support. Methods: Primary outcomes were cardiovascular clinical quality measures (CQMs) collected at baseline, 9 months, and 15 months. Implementation of the first 6 "Building Blocks of High-Performing Primary Care" was assessed by practice facilitators at baseline and 3, 6, and 9 months. CQMs from practices not involved in the study served as an external comparison. Results: A total of 211 practices completed baseline surveys. There were no differences by study arm (odds ratio [95% confidence interval]) for aspirin use (1.03 [0.99, 1.06]), blood pressure (0.98 [0.95, 1.01]), cholesterol (0.96 [0.92, 1.00]), and smoking (1.01 [0.96, 1.07]); however, there were significant improvements over time in aspirin use (1.04 [1.01, 1.07]), cholesterol (1.05 [1.03, 1.08]), and smoking (1.03 [1.01, 1.06]), but not blood pressure (1.01 [0.998, 1.03]). Improvement in enrolled practices was greater than external comparison practices across all 4 measures (all P < .05). Implementation improved in both arms for Team-Based Care, Patient-Team Partnership, and Population Management, and improvement was greater in enhanced intervention practices (all P < .05). Leadership and Data-Driven Improvement (P < .05) improved significantly, with no difference by arm. A greater improvement in Building Block implementation was associated with a greater improvement in blood pressure measures (P < .05). Conclusions: Practice transformation support can assist practices with improving quality of care. Patient engagement in practice transformation can further enhance practices' implementation of aspects of new models of care.

Patient engagement in the development and delivery of healthcare services: a systematic scoping review

“…As seen in online supplemental file 3, patient representatives organised in focus groups, workshops or forums were more likely to participate in an earlier phase of the engagement process than for other PE formats. Early, ongoing PE initiatives were endorsed as preferable over single and passive PE activities,25 26 36 46 56 57 with active visible dissemination from PE contributions,30 32 46 53 58 and patient representatives taking an active role through the entire PE process 25 26 31 38 58…”

Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices

“…The Building Blocks have informed practice improvement, and implementation science research; Perry et al show that implementation of this framework can be associated with improvement in clinical quality performance. 48 As practices and implementation scientists consider using this package to support improvement, our study identifies 3 important additions. First, consider the importance of fostering a commitment to community among practice members.…”

How Does Prior Experience Pay Off in Large-Scale Quality Improvement Initiatives?

“…The EvidenceNOW grantees (henceforth, called Cooperatives) have published the outcomes of their individual grants. [14][15][16][17][18][19][20] This article complements that work by reporting the results of a comparative analysis that examined differences among Cooperatives.…”