A national quality improvement initiative provides insight into how to successfully implement change in primary care practices

(Press-News.org) In 2015, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health. This three-year initiative, AHRQ’s largest-ever investment in primary care research, was designed to provide external quality improvement support to help small and medium-size primary care practices implement the latest evidence and improve their delivery of cardiovascular care. 

AHRQ awarded grants to primary care practices in seven regions across the U.S. to implement this initiative and to evaluate their own experiences with it, thereby accounting for regional differences in needs and existing resources. Additionally, AHRQ funded a technical assistance center to provide learning and support services to grantees. 

An independent, overarching evaluation of the initiative found that, despite challenges that often accompany quality improvement changes (eg, training staff, adding to their workload), the EvidenceNOW model successfully boosted the capacity of the participating practices to improve quality of care while helping to advance heart health. In AHRQ’s own reflections on the project, three key lessons emerged: 

(1) Change is neither one-size-fits-all nor straightforward. Quality improvement endeavors must be adaptable to suit the needs and resources of different practices. They also must allow for real-time flexibility to address unforeseen challenges. 

(2) Change is a collaborative effort. Its success depends on relationships among practice personnel, their individual well-being, and their capacity for and openness to change.

(3) While policymakers tend to expect immediate results, it can take years for substantive change to take hold in primary care practices and for the effects to become apparent. 

AHRQ believes these lessons make a case for developing a stable, well-funded infrastructure on a national level to provide ongoing external support for primary care practice transformation. Funding is needed to address broader issues with processes and services that most directly affect patient care. Most importantly, funding for practice transformation has to be ongoing, rather than tied to limited projects, in order to sustain and build on improvements.

What AHRQ Learned While Working to Transform Primary Care

Therese Miller, DrPH, et al

Agency for Healthcare Research and Quality, Rockville, Maryland

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