EvidenceNOW: The scale, scope to advance real practice improvement

LAG ABMS photo 1Larry A. Green, MD – Professor of Family Medicine, Epperson Zorn Chair for Innovation in Family Medicine and Primary Care,  University of Colorado, Anschutz Medical Campus

Pulling several networks into a ‘network of networks’ in EvidenceNOW is itself an advance in conducting policy-relevant research that is readily actionable at the community level by local clinicians.

EvidenceNOW manifests a scale and scope of practice-based innovation work that not-so-long ago was simply not accepted in the research community as plausible, possible or important.  Beyond the particulars of the questions being addressed by EvidenceNOW, the capacity to have large numbers of practices, joined in a collaborative effort to improve care, using common measures that matter to large numbers of people, continues to advance the idea AHRQ crystalized when John Eisenberg was its director: Instead of agonizing over moving research into practice, move research into practice.

Networks of practices as critical laboratories are still a relatively young infrastructure, continuing to mature with steady, persistent support from AHRQ, NAPCRG, professional societies and, increasingly, other agencies and entities striving to achieve the Triple Aim. Pulling several networks into a “network of networks” in EvidenceNOW is itself an advance in conducting policy-relevant research that is readily actionable at the community level by local clinicians. Conducting the projects, together with ESCALATES – a cross-cutting, unified evaluation – is a beautiful thing worth celebrating.

There are two aspects of EvidenceNOW that excite me most.  One is the union of the practice-based research movement with the continuing development, use and legitimation of multi-method research organized to assess effects, while also learning what it takes to make changes associated with desirable results. Another is the deployment of practice facilitation/extension services on a substantial scale in different localities. The ACA authorized the development of a healthcare extension service akin to the wildly successful agricultural extension service, and EvidenceNOW moves such authorization into action in the field.  Much will be learned about the structure and function of what is basically a ”health extension” service, advancing further a critical infrastructure needed for widespread, constant practice improvement, to the benefit of virtually every person in our country. This, all by itself, is a big deal.

It is a privilege to have the opportunity to participate in a small way with such an important set of endeavors, working with such committed and imaginative individuals. It is amazing and refreshing to work with practices that in the current tsunami of redesign mustered the courage and energy to overcome “change fatigue” and do some really heavy lifting.  I hope the funders and beneficiaries of its results share with me a deep sense of gratitude for these wonderful practices.