HHS’ Million Hearts initiative prioritized ABCS (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) clinical quality measures throughout the healthcare delivery system.
To evaluate several strategies for enhancing ABCS performance and outcomes in low-volume primary care settings, AHRQ’s Evidence Now project funded 7 collaboratives. One of the methods presented in Evidence Now was developed by the Heart of Virginia Health care (HVH) partnership. Over the course of the initiative’s 3 cohorts, 177 practices using 16 distinct electronic health record (EHR) systems remained after being recruited from among the qualified population of 264.
To boost overall practice operation and performance on the ABCS measures, certified practice coaches disseminated the practice support curriculum. The intervention included a first meeting to set goals, 3 months of intensive help, 9 months of ongoing support, and access to online learning resources and professional instructors. The average time spent in interaction with coaches during practice was 428 minutes, with a spread of just 426 minutes. Overall, the short HVH intervention had small but statistically significant positive average effects on the appropriate use of aspirin and other antithrombotics; small negative effects on blood pressure control; and small negative effects on smoking cessation counseling; however, these results only held true for practices that participated in the kickoff. In addition, recruiting enough practices proved challenging; thus, the intervention period had to be cut short.
This probably influenced why the ABCS has yet to make any major strides forward. A number of other issues, such as the frequency of large disruptions to the practice and researchers’ inability to provide real-time feedback on metrics, undoubtedly played a role as well. Time should be allotted for internal practice recruitment and external support in future efforts to improve primary care practice function.