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Topic

Healthy Hearts Northwest: A 2×2 Randomized Factorial Trial to Build Quality Improvement Capacity in Primary Care

Presenter

Michael L. Parchman MD, MPH, Director of the MacColl Center for Health Care Innovation at the Kaiser Permanente Washington Health Research Institute, and Principal Investigator for the Healthy Hearts Northwest trial

Keywords

Cardiovascular health; Quality improvement; Primary care networks; Agency for Healthcare Research and Quality; Comparative effectiveness research; Chronic medical conditions; Practice facilitators; Shared learning; Educational outreach; Plan-Do-Study-Act; PDSA

Key Points

  • Healthy Hearts Northwest is one of 7 studies funded by the Agency for Healthcare Research and Quality conducted in regional cooperatives across 12 states. The trial is comparing the impact of different implementation strategies for building quality improvement (QI) capacity within smaller primary care practices, with a focus on cardiovascular risk factors.
  • Most primary care practices do not have the time, resources, or expertise needed to focus on practice improvement. This trial will evaluate whether combining practice-support strategies will lead to improvements in clinical performance measures for cardiovascular disease, such as aspirin use, blood pressure control, cholesterol management, and smoking cessation. These strategies include:
    • Practice facilitation, involving a trained individual or team visiting sites and using a range of organizational development, project management, QI, and practice improvement approaches to help build capacity over time to reach incremental, transformative improvement goals
    • Educational outreach, involving a trained outside expert delivering one or more educational messages to health professionals to improve guideline-concordant behavior
    • Shared learning opportunities, a collaborative approach pioneered by the Institute for Healthcare Improvement used to motivate change

Discussion Themes

The target of the intervention, and the unit of recruitment and analysis, is the small primary care practice of fewer than 10 providers. The study’s sample is representative of typical practices where the majority of the U.S. population receives care.
Primary care practices often contend with competing priorities as well as disruptions such as staff turnover, EMR changes, and organizational mergers. Yet even small primary care practices can carve out space to sit down and figure how to improve. Small inputs can have big effects.

For More Information

Read more about the Healthy Hearts Northwest project: http://healthyheartsnw.org/
Study protocol for Healthy Hearts Northwest is published in Implementation Science (open access)
Building Quality Improvement Capacity in Primary Care (Taylor et al. 2013 AHRQ Pub # 13-0044-2-EF)

Tags

#HealthyHeartsNorthwest, #pctGR
@PCTGrandRounds, @Collaboratory1, @PCORnetwork
 

 Grand Rounds 4-7-17

 
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