• Bijal A Balasubramanian, Stephan Lindner, Miguel Marino, Rachel Springer, Samuel T Edwards, K John McConnell, and Deborah J Cohen.
• From Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX (BAB; Center for Health Systems Effectiveness and Department of Emergency Medicine, Oregon Health & Science University, Portland, OR (SL, KJM); Department of Family Medicine, Oregon Health & Science University, Portland, OR (MM, RS, STE, DJC); School of Public Health, Oregon Health & Science University, Portland, OR (MM); Section of General Internal Medicine, Veterans Affairs (VA) Portland Health Care System, Portland OR (STE); Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR (STE); Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland OR (STE); Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR (DJC). bijal.a.balasubramanian@uth.tmc.edu.
• J Am Board Fam Med. 2022 Sep 12.

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. MethodsSeven 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. ResultsMean 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. ConclusionsEvidenceNOW 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.© Copyright by the American Board of Family Medicine.

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