What AHRQ Learned While Working to Transform Primary Care

Abstract

Building on previous efforts to transform primary care, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in 2015. This 3-year initiative provided external quality improvement support to small and medium-size primary care practices to implement evidence-based cardiovascular care. Despite challenges, results from an independent national evaluation demonstrated that the EvidenceNOW model successfully boosted the capacity of primary care practices to improve quality of care, while helping to advance heart health. Reflecting on AHRQ's own learnings as the funder of this work, 3 key lessons emerged: (1) there will always be surprises that will require flexibility and real-time adaptation; (2) primary care transformation is about more than technology; and (3) it takes time and experience to improve care delivery and health outcomes. EvidenceNOW taught us that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to a specific disease or initiative. We believe these lessons argue for a national primary care extension service that provides ongoing support for practice transformation.

Keywords: Agency for Healthcare Research and Quality (AHRQ); EvidenceNOW; health extension; practice facilitation; practice transformation; primary health care; quality improvement.

Figure 1.

EvidenceNOW grantees and technical assistance contractor. AHRQ = Agency for Healthcare Research and Quality; ESCALATES = Evaluating System Change to Advance Learning and Take Evidence to Scale; NYC = New York City; TAC = Technical Assistance Center. Note: AHRQ awarded grants to 7 regional cooperatives as part of the original EvidenceNOW initiative. Each cooperative successfully recruited and engaged 200-250 small and medium-sized primary care practices and provided quality improvement support services (see Figure 2). AHRQ also awarded a grant to support the national evaluation of EvidenceNOW, known as Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES), and established an EvidenceNOW Technical Assistance Center to support the implementation and evaluation grantees. Sources: https://www.ahrq.gov/evidencenow/projects/heart-health/about/cooperatives/index.html and https://www.ahrq.gov/evidencenow/projects/heart-health/research-results/research/national.html

Figure 2.

EvidenceNOW quality improvement services. IT = information technology. Source/Notes: https://www.ahrq.gov/evidencenow/model/index.html