Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

Abstract

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services.

Keywords: Health Reform; Organization and Delivery of Care; Primary Care; Quality Of Care.

Exhibit 1. Practices in EvidenceNOW

SOURCE Authors’ analysis of data from the EvidenceNOW evaluation. NOTES Each circle represents a ZIP code where one or more practices participate in an EvidenceNOW Cooperative, which coordinates its work through a hub. States grouped by color represent a single EvidenceNOW Cooperative. The hubs are as follows: (1) Kaiser Permanente Washington Health Research Institute, in Seattle; (2) Oregon Health & Science University, in Portland; (3) the University of New Mexico, in Albuquerque; (4) the University of Colorado, in Denver; (5) the University of Oklahoma, in Tulsa; (6) Northwestern University, in Chicago; (7) George Mason University, in Fairfax, VA; (8) the University of North Carolina at Chapel Hill; and (9) New York University, in New York City. The inset shows the New York City ZIP codes.