An ambitious project led by Northwestern University researcher Abel Kho, M.D., will try to establish quality guidelines for heart health in primary care practices in southeastern Wisconsin, northeastern Illinois, including Chicago, and northern Indiana.

The three-year project, dubbed “Healthy Hearts in the Heartland,” is one of seven nationwide funded by the Agency for Healthcare Research and Quality's EvidenceNOW program, which is meant to transform healthcare delivery by building a critical infrastructure to help smaller primary care practices improve the heart health of their patients by applying the latest medical research and tools.

Also See: HHS Grants to Advance Heart Health with EHR Support

One intriguing aspect of the project, which received $15 million in AHRQ funding, is the alliance of four Regional Extension Centers, state departments of health, quality improvement organizations, and the American Medical Association, and linkages with pharmacies and smoking cessation quit lines. The project is aimed not at large health systems but rather at smaller independent primary practices, which may not have the informational infrastructure to fully implement quality improvement measurement initiatives. According to Kho, the AHRQ's intentions dovetailed very well with existing relationships he and his colleagues in the region had with primary care providers in the target demographic.

"Keep in mind the whole REC program was focused primarily on getting the smaller clinics that serve underinsured, uninsured, and underserved populations to meaningful use of electronic health records," said Kho, director of Northwestern's Center for Health Information Partnerships and the project's principal investigator. "When we saw this initiative come out it was a natural fit. We had already been working with the independent practices for the past five years. We knew a lot of these guys around Chicago. A lot of our partner RECs in other states knew the guys in their areas."

The study, Kho said, is meant to help those providers answer what he calls an ubiquitous question and its subtext: "After you've put EHRs in place and have reached meaningful use, at least Stage 1, all the doctors ask the same question: ‘What can I do now that I have it in  place? How can I use it to improve quality of care?' And the subtext there is 'Can I use it to help get qualified for some of the incentive payments for quality of care coming down the pipeline?'"

The project will attempt to ascertain baseline quality measurements, and subsequently disseminate best practices, around the Department of Health and Human Services' Million Hearts "ABCS" campaign, the components thereof being appropriate aspirin therapy, blood pressure control, cholesterol management, and smoking cessation.

The initial setting of quality baselines will be facilitated by "at the elbow" support from REC personnel who can help participating clinic staffers correctly enter quality data into their EHRs, something Kho said does not always happen.

"People sometimes don't put things in the right field, or they don't fill things out. They may put it in their notes instead of somewhere else where they are supposed to. We've always seen that when people fill out these native EHR quality reports," he said, adding that in pilot programs gauging the effectiveness of REC support staff, documentation quality goes up.

Once the project's initial quality baseline is established, Kho said the researchers will begin establishing intervention protocols to improve ABCS compliance. Those protocols will include traditional clinical decision support systems; identifying populations that are out of compliance and doing outreach to them; or putting tools in place that would push patients to other community partners where they could receive remediation on some of the ABCS measures – for example, referring patients to a smoking cessation hotline even before they see their clinician, or doing blood pressure control follow-up care through pharmacies near patients' homes.

In addition to using native EHR platforms, Kho said the researchers hope to deploy an open-source quality measurement platform originally developed by the Mitre Corporation, called PopHealth. Northwestern researchers have used it, have contributed to the code, and in fact, Kho said, Northwestern was the first place in the country to get it certified for meaningful use reporting.

"That can be made available across practice types and EHRs and will allow people to compare themselves against other clinics and places nearby them as well as the whole region," Kho said.

And, while much of the industry is gearing up for an expected wave of consolidation among providers, Kho said he is aware of plenty of tech-savvy primary care physicians who are determined to remain independent, and stand to benefit from the regional quality improvement approach the project is undertaking.

"Many of them are on EHRs," he said. "Some have gone to the concierge model, but other groups who are still serving Medicare and Medicaid populations are pooling together into large collaborations or alliances of several hundred practitioners and are consolidating a lot of their administrative overhead. They are also positioning themselves incredibly well for what's coming down the pipeline, which is going to be quality improvement and measurement and care coordination. Some of these guys are thinking, 'We can do this as well as, if not better, than the larger systems,' and it's really impressive."

Members of Healthy Hearts in the Heartland include Northwestern University and the Chicago Health IT Regional Extension Center (CHITREC), Purdue University and the Purdue Regional Extension Center (PurdueREC), Northern Illinois University and the Illinois Regional Extension Center (IL-HITREC), local and state departments of public health, the American Medical Association, the Alliance of Chicago, University of Chicago, Telligen (Illinois’ Medicare Quality Improvement Organization) and Metastar (a Quality Improvement Organization and Regional Extension Center for Wisconsin).

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