By David Meyers, M.D.
Chief Medical Officer, AHRQ
EvidenceNOW, a large grant-funded initiative from the Agency for Healthcare Research and Quality, is seeking to understand how to assist small primary care practices in implementing evidence into the care they deliver. Seven regional cooperatives are providing quality improvement support to over 1500 primary care practices with a focus on increasing the delivery of the ABCS of heart health:
These four practices, which underpin Million Hearts® – a national initiative led by the Department of Health and Human Services to prevent one million heart attacks and strokes by 2017—are among the most evidence-based interventions in health care. And yet, we know that many Americans, perhaps more than half of us, are not receiving them. Paraphrasing Chekov: Evidence is of little value unless put into practice. Each of the EvidenceNOW cooperatives will be evaluating whether and how the primary care practices with which they work increase the delivery of these evidence-based services.
You can learn more about EvidenceNOW, the cooperatives, and the program’s independent national evaluation at AHRQ.gov/EvidenceNOW.
Using the Evidence
AHRQ launched this initiative because of our recognition that understanding medical evidence is only the first step in the practice of evidence-based medicine. Understanding how to apply evidence in practice is a necessary second step. Since medical science is continually growing and changing, primary care teams must continually refine the delivery of care. EvidenceNOW recognizes that while primary care professionals are experts in providing care for individual patients, they are not always experts in delivery system design and refinement. EvidenceNOW cooperatives are providing small primary care practices resources they usually do not have access to:
In addition to evaluating whether these supports lead to an increase in the delivery of evidence-based heart health care, EvidenceNOW will be studying if and how these services affect each practice’s capacity for incorporating new evidence and ongoing quality improvement.
While targeting implementation of evidence, one of the challenges emerging in the early months of this 3-year initiative has been around understanding the evidence itself. Systematic reviews and the guidelines based on them form the core of the evidence base for EvidenceNOW. The area of cholesterol management underwent a seismic shift with the publication of new guidelines that reinterpreted the evidence away from LDL levels and towards optimal statin use. This change provides a strong test case for the EvidenceNOW approach as the Cooperatives begin working with primary care practices and helping them develop new workflows, care plans, and patient education materials that reflect this new approach. A greater challenge has been helping primary care teams understand how to incorporate important new individual studies into the well-established systematically reviewed evidence base. For EvidenceNOW this happened recently in the area of optimal blood pressure management:
- In 2014, an influential guideline group advocated for raising the blood pressure target for older adults.
- In 2015, in their New England Journal of Medicine publication of the results from the SPRINT trial, the authors of this large randomized controlled trial concluded that a substantially lower blood pressure target was best for older adults.
The EvidenceNOW community is wrestling with both the specifics of this situation and the larger issue of how to help busy primary care teams approach evidence in evolution.
I suspect the members of the GROWTH community will have suggestions for us and hope you will follow EvidenceNOW’s progress with us. I look forward to hearing from you. Who knows what additional connections will come from bumping into Sandy at that conference?