Improving Delivery of Cardiovascular Disease Preventive Services in Small-to-Medium Primary Care Practices

Background: The EvidenceNOW initiative provided smaller primary care practices with external support interventions to implement quality improvement strategies focused on cardiovascular disease prevention. This manuscript reports effectiveness of EvidenceNOW interventions in improving quality metrics. Metbods: Seven regional Cooperatives delivered external support interventions (practice facilitation, health information technology support to assist with audit and feedback, performance benchmarking, learn-ing collaboratives, and establishing community linkages) to 1278 smaller primary care practices. Outcomes included proportion of eligible patients meeting Centers for Medicaid and Medicare Services-specified ABCS metrics, that is, Aspirin for those at risk of ischemic vascular disease; achieving target Blood pressure among hypertensives; prescribing statin for those with elevated Cholesterol, diabetes, or increased cardio-vascular disease risk; and screening for Smoking and providing cessation counseling. An event study com-pared prepost changes in outcomes among intervention practices and a difference-in-differences design compared intervention practices to 688 external comparison practices. Results: Mean baseline outcomes ranged from 61.5% (cholesterol) to 64.9% (aspirin). In the event study, outcomes improved significantly (aspirin: +3.39 percentage points, 95% CI, 0.61-6.17; blood pres-sure: +1.59, 95% CI, 0.12-3.06; cholesterol: +4.43, 95% CI, 0.33-8.53; smoking: +7.33, 95% CI, 4.70- 9.96). Difference-in-differences estimates were similar in magnitude but statistically significant for smoking alone. Preintervention trends were significant for smoking, but parallel-trends tests were not significant. Conclusions: EvidenceNOW Cooperatives improved cardiovascular prevention quality metrics among small and medium sized primary care practices across the US. While estimated improvements were small, they reflected average changes across a large and diverse sample of practices. ( J Am Board Fam Med 2022;35:968-978.)

Automated summary

The EvidenceNOW initiative improved cardiovascular disease prevention quality metrics among small and medium sized primary care practices in the US. While the improvements were modest, they represented average changes across a large and diverse sample of practices.