title: A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.
abstract: The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES).
  
  
  
  This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness.
  
  
  
  ESCALATES is a national evaluation of an ambitious large-scale dissemination and implementation effort focused on transforming smaller primary care practices. Insights will help to inform the design of national health care practice extension systems aimed at supporting practice transformation efforts in the USA.
  
  
  
  NCT02560428 (09/21/15).
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. cohendj@ohsu.edu.|Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. cohendj@ohsu.edu.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Dallas Regional Campus, Dallas, TX, USA.
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Gordon
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.|Department of Veteran Affairs, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ono
authors.affiliation: HealthPartners Institute, Minneapolis, MN, USA.
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.affiliation: Department of Family Medicine and Community Health, Rutgers-Robert Wood, Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.affiliation: Departments of Family Medicine and Community Health, Epidemiology and Biostatistics, Sociology and the Case Comprehensive Cancer Center, and Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.|Oregon, Rural Practice-Based Research Network, Portland, OR, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Davis
authors.affiliation: Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.affiliation: Center for Clinical Management Research and PROVE QUERI, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: Center for Health Systems Effectiveness and Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John
authors.initials: J
authors.lastname: Creswell
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*; D011446:Prospective Studies; D012107:Research Design
keywords: Cardiovascular disease prevention; Dissemination and implementation research; Multi-site evaluation; Practice capacity; Practice facilitation; Primary care practice; Primary care practice extension; Quality improvement; Regional learning collaboratives