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PURPOSE We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. METHODS A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point Quality Improvement Capacity Assessment (QICA). Clinics reported performance on 3 cardiovascular CQMs--appropriate aspirin use, blood pressure (BP) control ( RESULTS Practices improved QICA scores by 1.44 points (95% CI, 1.20-1.68; P CONCLUSIONS Improvements in clinic-level performance on BP control may be attributed to implementation of 7 evidence-based strategies to build quality improvement capacity. These strategies were feasible to implement in small practices over 15 months. Key words: practice facilitation; high-leverage change; quality improvement; cardiovascular disease; risk factors; preventive medicine; evidence-based practice; clinical quality measure; Healthy Hearts Northwest study; EvidenceNOW; AHRQ; organizational innovation, INTRODUCTION Primary care practices in the United States are in a period of transition, with considerable pressure from payers and policy makers to improve quality of care and reduce costs. [...]

Context: High blood pressure (HBP) affects nearly half of adults in the United States and is a major factor in heart attacks, strokes, kidney disease, and other morbidities. Many primary care guidelines exist for reducing risk, including several related to patient behaviors such as home monitoring and lifestyle changes. Patient-facing, primary care-based clinical decision support (CDS) tools may help patients adhere to evidence-based recommendations, but a deeper understanding of their motivations and preferences will be necessary to succeed. Objective: Understand how to best engage patients in controlling their HBP, in order to design effective patient facing CDS tools. Population Studied: Adults between the ages of 18 and 85 who had been diagnosed with hypertension. Study Design: Mixed methods study with two phases: (1) 18 semi-structured interviews with a limited cohort; and (2) a nationwide online survey of 519 people. Instrument: Both the interviews and the survey included questions assessing comorbid conditions, medication load, treatment priorities, satisfaction with BP management goal-setting, and attitudes towards CDS. The survey also included a set of dichotomous (A/B) preference questions using paired information displays to assess perceived trustworthiness of potential CDS user interface options and likelihood of initiating patient action. Analysis: Interview responses were summarized using descriptive statistics with content analysis on the open-ended questions. Survey questions using a 7 point Likert scale were summarized by percent responding in the top 3 categories. A/B preference displays were analyzed with a sign test and categorical responses about likelihood of taking action were compared using a chi-squared test at the p=0.05 level. Results: Patients knew their BP goals, and identified that behavioral and lifestyle changes were important and underutilized. Social-relational and higher information displays were perceived as more trustworthy (55-60% vs. 16-26%) but did not change reported actions (75%). Conclusions: Our survey results suggest that patients perceive they would act on information and recommendations displayed by a CDS tool; however, significant previous work has shown that people tend to over-estimate their own actions. A first version of the CDS tool has been developed, and the next steps include testing the visualizations, reminders, and tailored messages in the real world through a pragmatic trial., Presenters Michelle Bobo, BA, MS, David Dorr, MD, MS, Anthony Cheng, MD, Christopher d'Autremont, MBI, Christopher Terndrup, MJ Dunne, MA, Robert Rope, MD, Joshua Richardson, PhD, MLIS, [...]

PURPOSE We conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. METHODS Primary care practices across Washington, Oregon, and Idaho were eligible if they had fewer than 10 full-time clinicians. Practices were randomized to practice facilitation only, practice facilitation and shared learning, practice facilitation and educational outreach visits, or practice facilitation and both shared learning and educational outreach visits. All practices received up to 15 months of support. The primary outcome was the CQM for blood pressure control. Secondary outcomes were CQMs for appropriate aspirin therapy and smoking screening and cessation. Analyses followed an intention-to-treat approach. RESULTS Of 259 practices recruited, 209 agreed to be randomized. Only 42% of those offered educational outreach visits and 27% offered shared learning participated in these enhanced supports. CQM performance improved within each study arm for all 3 cardiovascular disease CQMs. After adjusting for differences between study arms, CQM improvements in the 3 enhanced practice support arms of the study did not differ significantly from those seen in practices that received practice facilitation alone (omnibus P = .40 for blood pressure CQM). Practices randomized to receive both educational outreach visits and shared learning, however, were more likely to achieve a blood pressure performance goal in 70% of patients compared with those randomized to practice facilitation alone (relative risk = 2.09; 95% CI, 1.16-3.76). CONCLUSIONS Although we found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation. Key words: primary health care; cardiovascular disease; quality improvement; chronic illness; prevention; health promotion; quantitative methods; health services; organizational change; practice-based research, INTRODUCTION Past efforts to transform primary care have included practice redesign based on medical home principles and adoption of electronic health records. (1-4) More recently, primary care practices face increasing [...]