The Northwest Coalition for Primary Care Practice Support

The Northwest Coalition for Primary Care Practice Support will provide a comprehensive and
robust external practice support infrastructure for small and medium primary care practices
across Washington (WA), Oregon (OR) and Idaho (ID) to build their internal quality
improvement (QI) capacity and improve performance on the heart health indicators of aspirin
use, blood pressure and cholesterol control and smoking cessation (ABCS indicators) by
disseminating and supporting the implementation of relevant Patient Centered Outcomes
Research findings. This coalition of partners has a remarkable track record of collaboration
and improving primary care practice: the MacColl Center for Health Care Innovation and the
Center for Community Health Evaluation at Group Health Research Institute; Qualis Health, the
Health IT Regional Extension Center (REC) and designated Quality Improvement Organization
(QIO) for WA and ID; and the Oregon Rural Practice-based Research Network (ORPRN), along with
state-level partners who are membership organizations for clinicians in small practice
settings. Recruitment will leverage existing small practice relationships between Qualis
Health as the health information technology (IT) REC for WA and ID and ORPRN's existing
network of small practices with a goal of enrolling 320 small practices out of an estimated
1,479 with stage 1 meaningful use of their electronic health record across the three states.
In addition to providing health IT support for the Physician Quality Reporting System (PQRS)
to measure the ABCS indicators in all practices, our comprehensive approach to building QI
capacity and improving the ABCS measures consists of: 1) practice facilitation as a unifying
strategy, 2) academic detailing/outreach to support implementation of PCOR findings, and 3)
shared learning collaboratives. We will employ an innovative study and evaluation design by
providing two levels of support for each of the latter three practice support components. By
randomly assigning practices to one of eight possible combinations of practice support, we
will "…develop new evidence about the contribution of various components of the comprehensive
approach and the effect of the intensity of the approach on outcomes." Our rigorous
mixed-method evaluation is based on the RE-AIM framework and will employ multi-level models
and interrupted time series regression. Data will be collected from a control group of
practices to examine secular trends. Our Specific Aims are to: 1) Identify, recruit and
conduct baseline assessments in 320 small to medium size primary care practices across the
geographically contiguous region of WA, OR and ID; 2) Provide comprehensive external practice
support to build QI capacity within these practices; 3) Disseminate and support the adoption
of PCOR findings relevant to the ABCS quality measures; 4) Conduct a rigorous evaluation of
the effectiveness of providing external practice support to implement PCOR findings and
improve ABCS measures; and 5) Assess the sustainability of changes made in QI capacity and
ABCS improvements and develop a model of dissemination and primary care practice support
infrastructure.

Inclusion Criteria:

- Primary care practice with 10 or fewer providers and an Electronic Health Record (EHR)
that meets Stage 1 meaningful use criteria

Exclusion Criteria:

- No EHR