Primary care is the bedrock of good health and well-being. Quality improvement (QI) is a process that primary care practices can engage in to ensure they are delivering evidence-based care. However, engaging in QI is often difficult for primary care practices that already face many challenges, such as an aging population with complex healthcare needs, tightening operating budgets, and high staff burnout and turnover. 

The Agency for Healthcare Research and Quality (AHRQ), designed EvidenceNOW, to help. EvidenceNOW: Advancing Heart Health was a three-year initiative that provided external QI support for small and medium-sized primary care practices to help improve their delivery of evidence-based cardiovascular care. Quality improvement support included on-site practice facilitation and coaching, health IT support, shared learning collaboratives, expert consultation, and data feedback and benchmarking. Seven grantees across the U.S. were part of the initiative, which included region-specific evaluations to assess how well EvidenceNOW worked. In addition, the initiative included an independent, overarching evaluation and a technical assistance center.

Building on the findings from the national and regional evaluations of EvidenceNOW: Advancing Heart Health, AHRQ is sharing their own learnings and insights in a new commentary in Annals of Family Medicine: “What AHRQ Learned While Working to Transform Primary Care.” These insights were developed through Abt’s contract to support the dissemination of findings from the EvidenceNOW initiative. The authors cite these core lessons: 

1. Change is not one-size-fits-all. Quality improvement work needs to adapt to the needs and resources of different practices. Unforeseen challenges are a given and adaptability is critical.   
2. Change requires collaborative effort. To be successful, the relationships between external QI support staff (such as practice facilitators) and the primary care clinicians and practice staff matters. Each individual’s well-being and capacity and openness to change are necessary ingredients for primary care transformation.  
3. Change takes time. To transform primary care, results can take many years for progress to take root and longer to see those results in data.  

In consideration of the lessons learned, the authors recommend that a national primary care extension service could provide critical support for practice transformation.