Northwestern researchers publish article on H3 practice facilitators implementation of CommunityRx-H3 in primary care practices

Monday, February 15 2021

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Purdue Healthcare Advisors (PHA) was one of seven universities and healthcare-industry partners that participated in Healthy Hearts in the Heartland (H3), a research program from 2015-2017 that focused on quality improvement and the prevention of strokes and heart attacks. 

CommunityRx-H3

H3 practice facilitators were trained to engage practices, conduct QI work, and use administrative tools for tracking and documentation. In addition to providing hands-on coaching to 60 small practices in Indiana on point-of-care support for Million Hearts© cardiovascular measures as well as support geared toward optimizing EHR clinical decision functionality, PHA's practice facilitators worked with practices to implement CommunityRx-H3, a community resource referral intervention. CommunityRx-H3 was an adaptation of CommunityRx, an evidence-based EMR-integrated community resource referral system developed and tested with more than 113,000 patients (nearly 30% with a CVD-related condition) in primary care and emergency care settings. CommunityRx used evidence-based algorithms to auto-generate a personalized community resource referral list called a “HealtheRx.” 

Publication and Findings

Researchers from Northwestern University, the prime recipient of the H3 grant, submitted an article to the Annals of Family Medicine to describe the primary care practices’ implementation of CommunityRx-H3, and concluded that practice facilitators, who are increasingly being utilized by primary care practices to support quality improvement interventions, play an important role in implementation science. 

As part of the research, qualitative focus groups were conducted with practice facilitators to elicit perceptions of practices’ experiences with CommunityRx-H3, practice-level factors affecting, and practice facilitator strategies to promote implementation. Qualitative data were analyzed using directed content analysis. The Consolidated Framework for Implementation Research was applied deductively to organize and interpret findings. Fourteen of all 19 practice facilitators participated.

• Practice facilitators perceived that staff attitudes about connecting patients to community resources for CVD were largely positive.
• Practices were already using a range of non-systematic strategies to refer to community resources. Practice-level factors that facilitated CommunityRx-H3 implementation included clinician “champions,” engaged practice managers, and a practice culture that valued community resources.
• Implementation barriers included a practice’s unwillingness to integrate the intervention into existing workflows, limited staff capacity to complete the resource inventory, and unavailability or cost of materials needed to print the resource referral list (“HealtheRx-H3”).
• Practice facilitator strategies to promote implementation included supporting ongoing customization of the
  HealtheRx-H3 and material support.
• Practice facilitators felt implementation would be improved by integration of CommunityRx-H3 with electronic medical record workflows and alternative methods for engaging practices in the implementation process. 

You can read more on their research methods here.

About the H3 Program:

Funded by a $15 million grant ($1.4M to PHA) from the Agency for Healthcare Research and Quality (AHRQ) and led by the Northwestern University Feinberg School of Medicine, H3 aimed to help providers in three states to use population-based tools and implement performance-measurement software in order to improve the overall health of their patient population. As an H3 partner, PHA helped practices with clinical decision support rules, and preparation for the coming changes to quality reporting and financial-incentive programs. PHA provided participating practices with direct assistance focused on six targeted specific heart-health measures required by the EvidenceNOW project and aligned with the Million Hearts initiative. These measures also fall within the scope of clinical quality measures associated with Meaningful Use (MU) and the Physician Quality Reporting System (PQRS). PHA provided participating practices with direct assistance focused on six targeted specific heart-health measures required by the EvidenceNOW project and aligned with the Million Hearts initiative. These measures also fall within the scope of clinical quality measures associated with Meaningful Use (MU) and the Physician Quality Reporting System (PQRS).

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Writer: Abramsohn et al. (2020) Implementation of Community-Based Resource Referrals for Cardiovascular Disease Self-Management, The Annals of Family Medicine, (6) 486-495; DOI: 10.1370/afm.2583, ,

Tags: Process & Cost Improvement (LEAN) , Quality Services