Seven strategies that may significantly improve quality of CVD care

Primary care clinics that implemented seven evidence-based strategies saw significant improvements in cardiovascular-related clinical quality measures, data showed.

“Smaller primary care practices often struggle with their quality improvement efforts,” Michael Parchman, MD, MPH, a senior investigator with Kaiser Permanente Washington Health Research Institute, told Healio Primary Care. “We did not know if providing external support focused on increasing their quality improvement capacity would do so, nor if improving quality improvement capacity would be associated with improved clinical care quality.”

The researchers enrolled 209 primary care practices in Washington, Oregon and Idaho — each utilizing fewer than 10 full-time clinicians in one location. The final analysis included 165 practices.

A practice facilitator trained clinicians and staff to test and implement the following “high-leverage changes” within their practices:

• “Embed clinical evidence into daily work to guide how care is delivered to patients.”
• “Utilize data to understand and improve clinical performance measures.”
• “Establish a regular quality improvement process involving cross-functional teams.”
• “Identify at-risk patients through proactive population management and outreach.”
• “Define roles and responsibilities across the team to improve care.”
• “Deepen patient self-management support to improve clinical outcomes.”
• “Link patients to resources outside of the clinic to support patients.”

According to Parchman, these changes were drawn from the Safety Net Medical Home Initiative, a program geared towards implementing the patient-centered medical home model.

The practices reported their clinic’s overall performance on three CMS clinical quality measures: appropriate aspirin use, BP control and tobacco cessation counseling. These quality measures were collected at baseline and during quarterly visits each year for 2 years.

Each practice was graded on a Quality Improvement Capacity Assessment (QICA) score from 1 to 12. A score of 1, 2 or 3 indicated the practice did not engage in the activity and a score of 10, 11 or 12 indicated the practice was consistent in its “use of, or application of, best practice care,” the researchers wrote.

At baseline, the practices’ average QICA score was 6.45. By study’s end, the average scores improved by 1.44 points (95% CI, 1.2-1.68). The practices’ compliance regarding appropriate aspirin use increased 3.98% (average baseline = 66.8%; 95% CI, 1.17-6.79); compliance with BP control increased 3.36% (average baseline = 61.5%; 95% CI, 1.44-5.27); and tobacco screening and cessation counseling increased 7.49% (average baseline = 73.8%; 95% CI, 4.21-10.77).

“This study makes a unique contribution to the literature by demonstrating that the seven high-leverage changes may provide a reasonable set of activities for small practices to undertake over a relatively short time period to build their quality improvement capacity for the purpose of improving clinical outcomes,” the researchers wrote.

Parchman said in the interview that study participants “expressed a high degree of satisfaction with what they had accomplished, and many asked for continued support from their practice facilitator after the end of the project.”

He added that such support, “although discussed for many years,” does not currently exist, but he encouraged practices to utilize CMS’ QICA tool “to evaluate where they are and where there is ‘low-hanging fruit’ for improving their quality improvement capacity.”

“A shift of just a few points can result in significant improvements in the quality of care they deliver,” Parchman said.