Building State Capacity Preliminary Findings
In 2021, AHRQ funded four grantees to develop State-level cooperatives to improve primary care practice, focusing initially on improving heart health. Preliminary findings from the project can be viewed in two interim evaluation reports, with a final report due next year.
The first interim evaluation report (PDF, 1.6 MB) provides an overview of each of the four cooperatives built for this project, the key barriers and facilitators to establishing a cooperative, and the strategies used to recruit participating practices. The report describes the challenges that grantees faced in setting up these cooperatives during the COVID-19 pandemic; their efforts to build a shared understanding of cooperative goals across participants; and common struggles with using electronic health records to document clinical quality.
The second interim evaluation report (PDF, 1.8 MB) highlights barriers and facilitators to establishing cooperatives and recruiting primary care practices to participate in care improvement efforts. It also details the processes grantees used to provide quality improvement support services using practice facilitation and other technical assistance methods. Specifically, the report highlights challenges with practice-level randomization in an environment where a growing proportion of primary care practices are affiliated with health systems. The report notes that engaging organizations with existing practice relationships is a key facilitator in this work, as is the importance of early and ongoing engagement with payers to ensure alignment of incentives with quality improvement efforts. The final evaluation report will examine the impacts of these efforts on improving heart health and reducing health disparities across the four participating states.
Key findings revealed by both reports:
- Having prior relationships with practices is critical to formation of state cooperatives
- Partnering with payers is necessary for sustainability and engaging these partners early would have improved the development process
- Building a "network of practices" apart from a specific project is difficult, with data collection demands being a particular challenge
- Recruitment incentives are insufficient for sustained engagement
- Randomization of practices is a barrier to engagement and retention, and system affiliation of practices makes this particularly challenging
- Obtaining and providing data for quality improvement (QI) requires specific resource commitments
- A longer period of performance (more than the 3 years in this project) is needed for effective QI engagement and support
- Infrastructure investment is needed to support QI and implementation capacity—especially around data use and feedback
