To help smaller primary care practices implement quality improvement techniques for the prevention of cardiovascular disease, the EvidenceNOW program provided external support interventions. This publication documents the positive impact that EvidenceNOW programs have had on quality indicator measures. 

An external support intervention (practice facilitation, health information technology support to aid with audit and feedback, performance benchmarking, learning collaboratives, and developing community links) was provided to 1,278 smaller primary care practices by 7 regional Cooperatives. For example, aspirin for those at risk of ischemic vascular disease; achieving target Blood pressure among hypertensives; prescribing statins for those with elevated Cholesterol, diabetes, or increased cardiovascular disease risk; screening for Smoking and providing cessation counseling; these are all outcomes measured by the Centers for Medicaid and Medicare Services. 

Intervention behaviors were compared to 688 external comparison practices using a difference-in-differences design, and pre-post changes in outcomes were compared using an event study. The mean results at baseline varied from 61.5% (cholesterol) to 64.9% (aspirin). Aspirin increased survival by +3.39% points (95% CI, 0.61-6.17); lowering blood pressure by +1.59% points (95% CI, 0.12-3.06); lowering cholesterol by +4.43% points (95% CI, 0.33-8.53); and quitting smoking by +7.33% points (95% CI, 4.70-9.96). Smoking was the only variable for which the difference-in-differences estimates differed significantly. There was a statistically significant upward trend in smoking before the intervention, but no parallel-trends tests were statistically significant.

Quality indicators for cardiovascular disease prevention in primary care practices of all sizes across the United States saw improvements due to participation in EvidenceNOW Cooperatives. While the estimated gains were modest, they reflected the mean transformations over a wide and heterogeneous set of activities.