EvidenceNOW: Balancing Primary Care Implementation and Implementation Research

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Figure 1
EvidenceNOW external quality improvement strategies.
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Figure 2
Geographic reach of EvidenceNOW.
ESCALATES = Evaluating System Change to Advance Learning and Take Evidence to Scale; TAC = Technical Assistance Center.

Table 1

Harmonized ABCS Measures

Measure	Definition
A: Aspirin use (Source: CMS164v4)	Proportion of patients aged 18 years and older who were discharged alive for acute myocardial infarction, coronary artery bypass graft or percutaneous coronary interventions in the 12 months before the measurement period, or who had an active diagnosis of ischemic vascular disease during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period
B: Blood pressure control (Source: CMS165v4)	Proportion of patients aged 18 to 85 years who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mm Hg) during the measurement period
C: Cholesterol management (Source: PQRS 438)	Proportion of the following patients—all considered at high risk of cardiovascular events—who were prescribed or were on statin therapy during the measurement period: Adults aged 21 years and older who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease, or Adults aged 21 years and older with a fasting or direct LDL-C level (≥190 mg/dL), or Adults aged 40–75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70–189 mg/dL
S: Smoking cessation (Source: CMS138v4)	Percentage of patients aged 18 years or older who were screened about tobacco use 1 or more times within 24 months and who received cessation counseling intervention if identified as a tobacco user

CMS = Centers for Medicare and Medicaid Services; EHR = electronic health record; LDL-C = low-density lipoprotein cholesterol; PQRS = Physician Quality Reporting System.

Table 2

Implementation Evaluation: Required Practice-Level Measures

Required Measures	Domain(s)
Change Process Capacity Questionnaire	Practice capacity
Measurement of adaptive reserve	Practice capacity
National Ambulatory Medical Care Survey Electronic Medical Records questionnaire (2010)	Internal context (includes practice organization, staffing, and patient population, and an assessment of the degree of EHR adoption of each practice and the ability of the practice to report quality measures)
Concurrent practice improvement initiatives	External context (for example, QIO/QINs, CMMI, CPCI, and TCPI)
Supporting strategies	External context (for example, pay-for-performance and public reporting initiatives)
Implementation and adaptation of comprehensive approach to quality improvement support	Possible aspects to address: acceptability, adoption, appropriateness, feasibility, fidelity, implementation costs, and sustainability
Intervention tracking	Specific strategies used with individual primary care practices (adaptation to local circumstances was allowed)

CMMI=Center for Medicare & Medicaid Innovation; CPCI=Comprehensive Primary Care Initiative; EHR=electronic health record; QIN=Quality Innovation Network; QIO=Quality Improvement Organization; TCPI=Transforming Clinical Practice Initiative.