RT Journal Article
SR Electronic
T1 Improving Delivery of Cardiovascular Disease Preventive Services in Small-to-Medium Primary Care Practices
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 968
OP 978
DO 10.3122/jabfm.2022.05.220038
VO 35
IS 5
A1 Bijal A. Balasubramanian
A1 Stephan Lindner
A1 Miguel Marino
A1 Rachel Springer
A1 Samuel T. Edwards
A1 K. John McConnell
A1 Deborah J. Cohen
YR 2022
UL http://www.jabfm.org/content/35/5/968.abstract
AB 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.Methods: Seven regional Cooperatives delivered external support interventions (practice facilitation, health information technology support to assist with audit and feedback, performance benchmarking, learning 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 cardiovascular disease risk; and screening for Smoking and providing cessation counseling. An event study compared 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 pressure: +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.