Although quality improvement strategies have been shown to improve care around the ABCS of cardiovascular disease (i.e. aspirin prescribing, blood pressure control, cholesterol management, and smoking cessation counseling), most studies of these strategies have been conducted in well-resourced academic institutions or integrated healthcare delivery systems. It is unclear whether these strategies can be effectively implemented in independent primary care practices with more limited resources and less developed quality improvement infrastructure. We propose to bring together the four Regional Extension Centers (RECs) covering Northeastern Illinois including Chicago, Southeastern Wisconsin, and Northwest Indiana, constituting the populous Tri-State corridor along Lake Michigan and collectively serving over 300 primary care practices. Our multi-stakeholder team includes State Departments of Public Health, the American Medical Association, the Alliance of Chicago, Telligen, Illinois' Medicare Quality Improvement Organization and Metastar (the QIO and REC for Wisconsin), to test the feasibility and effectiveness of point of care (POC) strategies (i.e., at the time of a visit) and population-management (PM) strategies (i.e. systems-based approaches to preventive and clinical care,) in EHR-enabled primary care practices. We will evaluate the ability of small practices in our region to implement POC and PM quality improvement strategies to improve the ABCS and implement the open source PopHealth performance measurement software to evaluate performance on the ABCS and enable regional benchmarking. We will conduct a practice-randomized trial to determine whether POC strategies improve ABCS performance measures compared to baseline, and whether adding locally-tailored PM strategies to POC strategies improves performance on the ABCS measures more than POC strategies alone. Finally, we will deploy an open source quality measurement platform (PopHealth) to establish a regional QI benchmarch based on participating practice ABCS measures and enable longitudinal tracking of electronic clinical quality measures (eCQMs) across our region. We will perform a mixed-methods evaluation to examine changes in practices' perceived capacity for quality improvement and whether access to comparative quality data within a region improves the capacity of practices to sustain their quality improvement program around the ABCS and provides a long term framework for practices to implement new QI activities. Our program will create a robust and sustainable quality improvement infrastructure positioned to translate PCOR findings efficiently into primary care practices within a region.
This project studies whether quality improvement strategies around the ABCS of cardiovascular disease can be effectively implemented in independent primary care practices with more limited resources and less developed quality improvement infrastructure than academic institutions and integrated healthcare delivery systems. We propose to study the feasibility and effectiveness of point of care strategies (i.e., at the time o a visit) and population-management strategies (i.e., a systems-based approach to improving health of a population) in EHR-enabled primary care practices.
| Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L et al. (2018) Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment? Ann Fam Med 16:S72-S79 |
| McHugh, Megan; Brown, Tiffany; Liss, David T et al. (2018) Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program. Ann Fam Med 16:S65-S71 |
| Richesson, Rachel L; Sun, Jimeng; Pathak, Jyotishman et al. (2016) Clinical phenotyping in selected national networks: demonstrating the need for high-throughput, portable, and computational methods. Artif Intell Med 71:57-61 |
