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Research ArticleRationale and Design

EvidenceNOW: Balancing Primary Care Implementation and Implementation Research

David Meyers, Therese Miller, Janice Genevro, Chunliu Zhan, Jan De La Mare, Alaina Fournier, Harriet Bennett and Robert J. McNellis
The Annals of Family Medicine April 2018, 16 (Suppl 1) S5-S11; DOI: https://doi.org/10.1370/afm.2196
David Meyers
Agency for Healthcare Research and Quality, Rockville, Maryland
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Therese Miller
Agency for Healthcare Research and Quality, Rockville, Maryland
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Janice Genevro
Agency for Healthcare Research and Quality, Rockville, Maryland
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Chunliu Zhan
Agency for Healthcare Research and Quality, Rockville, Maryland
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Jan De La Mare
Agency for Healthcare Research and Quality, Rockville, Maryland
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Alaina Fournier
Agency for Healthcare Research and Quality, Rockville, Maryland
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Harriet Bennett
Agency for Healthcare Research and Quality, Rockville, Maryland
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Robert J. McNellis
Agency for Healthcare Research and Quality, Rockville, Maryland
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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.

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    Table 1

    Harmonized ABCS Measures

    MeasureDefinition
    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.

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    Table 2

    Implementation Evaluation: Required Practice-Level Measures

    Required MeasuresDomain(s)
    Change Process Capacity QuestionnairePractice capacity
    Measurement of adaptive reservePractice 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 initiativesExternal context (for example, QIO/QINs, CMMI, CPCI, and TCPI)
    Supporting strategiesExternal context (for example, pay-for-performance and public reporting initiatives)
    Implementation and adaptation of comprehensive approach to quality improvement supportPossible aspects to address: acceptability, adoption, appropriateness, feasibility, fidelity, implementation costs, and sustainability
    Intervention trackingSpecific 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.

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    Table 3

    Implementation Evaluation: Encouraged Additional Practice-Level Measures

    Domains of measurement
    Practice capacity, adaptive reserve
    Leadership and organizational style
    Quality improvement structures and processes
    Team-ness
    Staff satisfaction and burnout
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The Annals of Family Medicine: 16 (Suppl 1)
The Annals of Family Medicine
Vol. 16, Issue Suppl 1
April 2018
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EvidenceNOW: Balancing Primary Care Implementation and Implementation Research
David Meyers, Therese Miller, Janice Genevro, Chunliu Zhan, Jan De La Mare, Alaina Fournier, Harriet Bennett, Robert J. McNellis
The Annals of Family Medicine Apr 2018, 16 (Suppl 1) S5-S11; DOI: 10.1370/afm.2196

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EvidenceNOW: Balancing Primary Care Implementation and Implementation Research
David Meyers, Therese Miller, Janice Genevro, Chunliu Zhan, Jan De La Mare, Alaina Fournier, Harriet Bennett, Robert J. McNellis
The Annals of Family Medicine Apr 2018, 16 (Suppl 1) S5-S11; DOI: 10.1370/afm.2196
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    • Abstract
    • INTRODUCTION
    • IMPLEMENTATION RESEARCH GRANT DESIGN DECISIONS
    • NATIONAL EVALUATION
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  • Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?
  • The Capacity of Primary Care for Improving Evidence-Based Care: Early Findings From AHRQs EvidenceNOW
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