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Virtual Educational Outreach Intervention in Primary Care Based on the Principles of Academic Detailing.

Routine provisionof evidence-based care in clinical practice is an elusive goal. In 2003, adults in theUnited States were receiving only about half of the care recommendations for 30 common conditions associated with substantial morbidity and mortality. Similar findings were reported for 175 indicators of quality of care for children across the United States Quality of care for US adults changed little between 2003 and 2016. With these sobering statistics as a backdrop, the Agency for Healthcare Research and Quality launched its EvidenceNOW initiative, creating and funding seven regional cooperatives to identify and implement effective strategies for improving quality of cardiovascular health care in community-based primary care practices. These cooperatives are testing implementation strategies tailored to hundreds of smallto medium-sized practices. Implementation strategies are “methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice” (eg, practice facilitation, educational outreach visits, shared learning collaboratives, anddata feedback and benchmarking). Healthy Hearts Northwest (H2N) is an EvidenceNOW cooperative that is apartnershipbetween theMacCollCenter forHealth Care Innovation at the Kaiser Permanente Washington Health Research Institute, Qualis Health in Washington and Idaho, the Oregon Rural Practice-based Research Network (ORPRN) based at the Oregon Health Sciences University, and the University of Washington's Institute of Translational Health Sciences. Qualis Health and ORPRN, both of which have worked with clinical practices on numerous practice improvement initiatives and research projects, recruited 259 practices across Washington, Oregon, and Idaho that had 10 full-time or fewer providers and met stage 1 electronic health recordmeaningful use criteria. Practices in H2N were as far as 829 miles from a research team hub. The H2N study is a four-arm pragmatic trial, with practices in all arms receiving external practice facilitation that supports quality improvement strategies to increase adoption of the four ABCS of heart disease prevention: Aspirin use by high-risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation. Practice facilitators hired by the H2N study provided 15 months of practice improvement support, making at least five face-to-face visits to each practice and monthly phone calls between visits. Each practice facilitator served geographic clusters of 10 to 20 practices. These external practice facilitators were trained in theModel for Improvement approach to quality improvement. The H2N study used a two-by-two factorial design to compare the effectiveness of adding educational outreach and shared learning opportunities to practice facilitation (PF) on practice quality improvement capacity and the ABCS clinical quality measures. The four factors (intervention arms) are (1) PF alone, (2) PF and shared learning, (3) PF and educational outreach, and (4) PF combined with both shared learning and educational outreach. Half of the H2N practices were randomly selected to receive the educational outreach intervention; half were randomized to a shared learning opportunity of a site visit to a practice using exemplar quality improvement strategies. The educational outreach intervention focused specifically on improving the “cholesterol management” measure by promoting routine use of a 10-year cardiovascular disease (CVD) risk calculator in a new population of adults—those 40 to 75 yearswithout previous atherosclerotic CVD, diabetes, or a lowdensity lipoprotein cholesterol over 190, as well as the use of statin medications for primary prevention among individuals with appropriate 10-year risk levels. This intervention was chosen based on evidence-based recommendations from the American College of Cardiology, the American Heart Association, and the US Preventive Services Task Force. This article focuses on the development of one component of the H2N study’s intervention—the virtual educational outreach program, which was adapted from the principles, structure, and elements of academic detailing (AD). AD is an effective method of modifying professional behavior in which a trained outside expert delivers evidence-based educational Disclosures: Fischer serves as a clinical consultant for Alosa Health, an educational