News and Updates for Healthcare Professionals

Only 12 percent of U.S. adults have the health literacy skills needed to manage the demands of our complex health care system, and even these individuals’ ability to absorb and use health information can be compromised by stress or illness. Experts recommend assuming that everyone may have difficulty understanding and creating an environment where all patients can thrive. Like with blood safety, universal precautions should be taken to address health literacy because we can’t know which patients are challenged by health care information and tasks at any given time. AHRQ’s Health Literacy Universal Precautions Toolkit – 2nd edition can help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.

Additional tools for improving health literacy:

• AHRQ Pharmacy Health Literacy Center
• Self-Management Support Video and Library

The AHRQ Primary Care Practice Facilitation (PCPF) Curriculum is a new resource designed to help train practice facilitators, also called practice coaches, quality improvement coaches, or practice enhancement assistants on how to take an evidence-based approach to quality improvement in primary care practices. This is the latest addition to the portfolio of AHRQ products that support the growth of practice facilitation. The PCPF Curriculum is organized into five parts:

• Use of Adult Education Methods in Teaching PCPF Core Competencies
• Introduction to Practice Facilitation
• Competencies for Practice Facilitators
• In the Practice
• Implementing the Care Model and Patient-Centered Medical Home

“AHRQ created this resource to support development of the workforce needed to provide quality improvement assistance to primary care practices,” said David Meyers, M.D., Chief Medical Officer, AHRQ. “There are a growing number of state and national quality improvement initiatives focusing on primary care, which will increase the demand for trained practice facilitators. A great example of the timeliness of this curriculum is its use by some of the grantees in EvidenceNOW – an AHRQ initiative working with over 1500 primary care practices to advance heart health.”

The PCPF curriculum supports the education and training of practice facilitators, and can be used by organizations that want to build a practice facilitation capacity, including payers, independent practice associations, accountable care organizations, and advocacy groups. Designed to be used as a resource when preparing new and experienced facilitators to work with primary care practices, the curriculum can also provide an introduction to principles and techniques of clinical quality improvement that can be used to educate other health care professionals.

Clinical Decision Support (CDS) is a key functionality of health IT that contributes to improved quality of care and enhanced outcomes by avoiding errors and adverse events, improving efficiencies, reducing costs, and enhancing provider and patient satisfaction.

For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2016, eligible professionals and eligible hospitals must meet the CDS objective by:

1. Implementing five CDS rules related to four or more clinical quality measures (CQMs) or related to a high-priority health condition for the EP, eligible hospital, or CAH’s scope of practice or patient population.
2. Enabling and implementing functionality for drug-drug and drug-allergy interaction checks.

CMS Guidance for CDS Interventions

The CDS objective gives providers flexibility in the types of CDS interventions they employ, as well as the timing of the CDS.

Providers can customize the implementation of the CDS to their own needs for their clinical practice and patient population. The CDS should be implemented at a “relevant point in patient care,” which refers to a relevant point in clinical workflows when the intervention can influence clinical decision-making before diagnostic or treatment action is taken in response to the intervention.

Additionally, providers are not limited to just “pop-up” alert CDS interventions. They can meet the objective by using other methods of CDS, including, but not limited to:

• Computerized alerts and reminders for providers and patients
• Information displays or links
• Clinical guidelines
• Condition-specific order sets
• Focused patient data reports and summaries
• Documentation templates
• Diagnostic support
• Contextually relevant reference information

Note: These functionalities may be deployed on a variety of platforms (e.g., mobile, cloud-based, installed).

To Learn More
For more information on CDS, review the specification sheets for eligible professionals and eligible hospitals.

People with Alzheimer’s disease need to stay active and do things they enjoy, but may have trouble deciding what to do each day. Try creating a schedule so the person does the same activities at a similar time each day and match the activities with their abilities. Doing physical activity like walking together can help both the person and the caregiver to manage stress and stay healthy.

From the NIH: Mind Your Risks raises awareness of the link between high blood pressure and cognitive impairment.

From the NIH: Mind Your Risks raises awareness of the link between high blood pressure and cognitive impairment.

Premature death rates have declined in the United States among Hispanics, blacks, and Asian/Pacific Islanders (APIs) — in line with trends in Canada and the United Kingdom — but increased among whites and American Indian/Alaska Natives (AI/ANs), according to a comprehensive study of premature death rates for the entire U.S. population from 1999 to 2014. This divergence was reported by researchers at the National Cancer Institute (NCI), and colleagues at the National Institute on Drug Abuse (NIDA), both part of the National Institutes of Health, and the University of New Mexico College of Nursing. The findings appeared Jan. 25, 2017, in The Lancet.

Declining rates of premature death (i.e., deaths among 25- to 64-year-olds) among Hispanics, blacks, and APIs were due mainly to fewer deaths from cancer, heart disease, and HIV over the time period of the study. The decline reflects successes in public health efforts to reduce tobacco use and medical advances to improve diagnosis and treatment. Whites also experienced fewer premature deaths from cancer and, for most ages, fewer deaths from heart disease over the study period. Despite these substantial improvements, overall premature death rates still remained higher for black men and women than for whites.

In contrast, overall premature death rates for whites and AI/ANs were driven up by dramatic increases in deaths from accidents (primarily drug overdoses), as well as suicide and liver disease. Among 25- to 30-year-old whites and AI/ANs, the investigators observed increases in death rates as high as 2 percent to 5 percent per year, comparable to those increases observed at the height of the U.S. AIDS epidemic.

“The results of our study suggest that, in addition to continued efforts against cancer, heart disease, and HIV, there is an urgent need for aggressive actions targeting emerging causes of death, namely drug overdoses, suicide, and liver disease,” said Meredith Shiels, Ph.D., M.H.S., Division of Cancer Epidemiology and Genetics (DCEG), NCI, lead author of the study.

“Death at any age is devastating for those left behind, but premature death is especially so, in particular for children and parents,” emphasized Amy Berrington, D.Phil., also of DCEG and senior author of the study. “We focused on premature deaths because, as Sir Richard Doll, the eminent epidemiologist and my mentor, observed: ‘Death in old age is inevitable, but death before old age is not.’ Our study can be used to target prevention and surveillance efforts to help those groups in greatest need.”

The study findings were based on death certificate data collected by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

At HHS, we are working toward transforming our health care system into one that puts individuals at the center. By making prices and quality information more accessible, providing the right tools to help people navigate the system, and listening to patients, we can help engage and empower people to take control of their health, something that’s good for them and good for our communities. Personally, I have seen first-hand what a difference the right information at the right time can make to someone facing a health care decision, which is why I signed on to help expand this work at HHS.

Earlier this month, Secretary Burwell hosted leaders who represent consumers, providers, health insurers, technology companies, and other industry perspectives to share their experiences with putting individuals at the center of the health care system and to help HHS leaders recognize ways we can walk the same path.

The U.S. Preventive Services Task Force released today a final recommendation statement on Screening for Depression in Adults. The Task Force recommends that clinicians screen all adults for depression. The Task Force found evidence that screening in the primary care setting is beneficial. To view the recommendation and the evidence on which it is based, please go to Final Recommendation Statement: Depression in Adults: Screening. A fact sheet that explains the final recommendation in plain language is also available. The final recommendation statement can also be found in the January 26, 2016 online issue of the Journal of the American Medical Association.

The U.S. Department of Health and Human Services announces the first meeting of the new Physician-Focused Payment Model Technical Advisory Committee on February 1, 2016. The Committee is required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and its members were appointed by the Comptroller General. On January 5, 2016, Secretary Burwell signed the Charter of the Committee. The Committee will review proposals for physician-focused payment models submitted by stakeholders based on criteria that the law requires the Secretary to establish through notice and comment rulemaking by November 1, 2016.

The Committee includes 11 members who are nationally recognized for their expertise in physician-focused payment models and related delivery of care. With authority delegated by the Secretary, the Assistant Secretary for Planning and Evaluation, Richard G. Frank, PhD has appointed Jeffrey Bailet, MD, as the Chairperson of the Committee and Elizabeth Mitchell as the Vice Chairperson of the Committee.

Dr. Bailet is an otolaryngologist and President of Aurora Health Care Medical Group in Wisconsin. Ms. Mitchell is President and Chief Executive Officer of the Network for Regional Healthcare Improvement in Maine.

Meeting information can be found by visiting the Federal Register Notice of Public Meeting.

More information can be found by visiting the Next Generation ACO, Pioneer ACO, Comprehensive ESRD Care Models web pages.

This notification is to update states and stakeholders on the finalization of the Affordable Care Act Federal upper limits (FUL) for multiple source drugs. The Centers for Medicare & Medicaid Services (CMS) plans to publish draft Affordable Care Act FULs calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment (CMS-2345-FC) for two months beginning in January 2016 before finalizing the FULs. The final Affordable Care Act FULs will be published in late March 2016 and will be effective on April 1, 2016 to coincide with the effective date of the final rule with comment. States will have up to 30 days from the April 1, 2016 effective date to implement the FULs. Thereafter, the FULs will be updated monthly on the Medicaid.gov website, and will be effective on the first date of the month following the publication of the update. States will, likewise, have up to 30 days after the effective date to implement the FULs. CMS also plans to publish an updated Methodology and Data Elements Guide used to calculate these draft FULs.

CMS will issue a monthly Listserv notification when the updated draft FULs are available on the Medicaid.gov website, and when the FULs are finalized. Further, CMS will continue to issue these monthly Listserv notifications to stakeholders when the updated monthly FULs are available on the Medicaid.gov website for the first six months after the finalization of the FULs.

Although CMS will no longer be publishing the draft Affordable Care Act FULs based on the methodology proposed in the Notice of Proposed Rulemaking (CMS-2345-P) (77 FR 5345) published in February 2012, those draft files and the draft Methodology and Data Elements Guides used to calculate those FULs will be available on the Medicaid.gov website at the address provided below.

Once we publish the final Affordable Care Act FULs, the prior FULs calculated using the methodology at 42 CFR 447.332 (FUL Changes Made To Transmittal No.37 and Transmittal No.37 – FUL November 20, 2001), as in effect on December 31, 2006, under the authority of the Medicare Improvements for Patients and Providers Act of 2008 will no longer be in effect.

We look forward to continuing to work with you as you apply the provisions of the Affordable Care Act.

Today, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive in the health care system and lower costs. With this announcement, ACOs now represent 49 states and the District of Columbia.

ACOs are delivering better care, and they continue to show promising results on cost savings. In 2014, they had a combined total net program savings of $411 million for 333 Medicare Shared Savings Program (Shared Savings Program) ACOs and 20 Pioneer ACOs. Based on 2014 quality and financial performance results for Shared Savings Program ACOs who started the program in 2012, 2013, and 2014, those that reported in both 2013 and 2014 improved on 27 of the 33 quality measures, including patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, screening for tobacco use and cessation, screening for high blood pressure, and Electronic Health Record use. Shared Savings Program ACOs also outperformed group practices reporting quality on 18 out of 22 measures.

CMS also announced today that providers and hospitals have signed up to join new types of ACOs, which in addition to being paid for positive patient outcomes will also receive penalties for negative ones. With new participants in the Shared Savings Program (SSP), the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive ESRD Care Model, there will now be:

• Nearly 8.9 million beneficiaries served
• A total of 477 ACOs across SSP, Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model
• 64 ACOs are in a risk-bearing track including SSP, Pioneer ACO Model, Next Generation ACO Model , and Comprehensive ESRD Care Model

More information can be found by visiting the Next Generation ACO Model, Pioneer ACO Model, Comprehensive ESRD Care Model web pages.

Due to an error found in the logic, the Centers for Medicare & Medicaid Services (CMS) is providing guidance on measure CMS122 (Diabetes: Hemoglobin A1c Poor Control), which is included in the 2014 measure set for the Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs). Version CMS122v3 of the measure was posted on the CMS website in May 2014. A subsequent posting of this measure in 2015 (CMS122v4) resolved this issue for the 2016 program year.

Background

CMS122 measures the percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement year. A patient meets the numerator condition if any of the following are true:

1. The most recent HbA1c reading is > 9.0%;
2. The most recent HbA1c result is missing; or
3. If there are no HbA1c tests performed and results documented during the measurement period.

CMS122 is an inverse measure, meaning that lower scores indicate better performance. In 2014, this measure was updated as CMS122v3 to include logic and specifications for numerator condition (2), where there is evidence of a laboratory test’s having been performed, but the result of the test was not recorded. This logic introduced an error, which results in patients with HbA1c laboratory results of less than 9.0% as being numerator compliant, artificially inflating the (inverse) performance score.

What should you do if you report this measure?

Version CMS122v3 affects the 2015 program year and 2017 payment year for several programs including the Physician Quality Reporting System (PQRS), the Medicare EHR Incentive Program, the Value-Based Payment Modifier (VM) and the Comprehensive Primary Care (CPC) initiative. Guidance for each program is provided below.

• PQRS
  Reporting CMS122v3 will count as one of the nine measures required to satisfactorily report for the PQRS program. For PQRS questions regarding CMS122v3, please contact the QualityNet Help Desk at Qnetsupport@hcqis.org or 1-866-288-8912, TTY: 1-877-715-6222.
• 
  EHR Incentive Programs
  Reporting CMS122v3 will count as one of the nine measures required to satisfactorily report for the EHR Incentive Programs. For questions regarding CMS122v3, please contact the EHR Incentive Programs Information Center at 1-888-734-6433 or TTY 1-888-734-6563.
• Value Modifier (VM) Program
  Based on this logic error, CMS will not include CMS122v3 in the calculation of the Quality Composite for the CY 2017 Value Modifier. For VM questions regarding CMS122v3, please contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 1-888-734-6433 (press option 3).
• Comprehensive Primary Care Initiative (CPC)
  All practices are required to report 9 measures from the 13 CPC eCQM measures. If a practice is unable to report on a different CPC eCQM, then they should report this measure to meet the 9 measure reporting requirement for the CPC program. For 2015 CPC Medicare shared savings, CMS will not include this measure in performance calculations for quality scoring purposes. Practices that report on CMS122v3 will still be eligible to receive any Medicare shared savings based on their other reported eCQMs. For CPC questions regarding CMS122v3, please contact the CPC Support at: cpcisupport@telligen.org or 1-800-381-4724.

For more information on eCQMs, visit the
eCQM Library.

AHRQ offers continuing education (CE) and continuing medical education (CME) videos and articles on a range of health care topics including patient safety and patient-centered outcomes research findings. The CE/CME activities summarize reviews of evidence on the effectiveness and safety of treatments and strategies for improving patient care. These resources provide health care providers with skills and information to support individual decision making and patient management.

The term insomnia is variously defined to describe a symptom and/or a disorder. It involves dissatisfaction with sleep quantity or quality and is associated with one or more of the following subjective reports: difficulty initiating sleep, difficulty maintaining sleep, or early morning waking with inability to return to sleep.

Detailed plan sets course for advancing scientific discoveries and human health.

A new online report provides an easy-to-read overview of recent National Institutes of Health-funded research advances and initiatives in Alzheimer’s disease and related dementias. Issued by the National Institute on Aging (NIA) at NIH, the annual report — 2014-2015 Alzheimer’s Disease Progress Report: Advancing Research Toward a Cure — discusses research momentum under the National Plan to Address Alzheimer’s Disease, describes research opportunities, and summarizes scientific advances in several areas:

• Understanding the biology of Alzheimer’s, related dementias, and the aging brain
• Identifying genetic influences on risk for late-onset Alzheimer’s, the most common form
• Detecting the earliest Alzheimer’s-related brain changes, including further development of biomarkers to track the onset and progression of Alzheimer’s
• Understanding gender and racial differences in the impact of Alzheimer’s
• Stepping up translational research enabling the design and testing of new drugs
• Testing in clinical trials potential new therapies to prevent, delay or treat Alzheimer’s
• Finding better ways to support caregivers

The report includes searchable tables of NIA-funded clinical trials that are testing promising interventions for Alzheimer’s disease, mild cognitive impairment, age-related cognitive decline, delirium and dementia-related psychiatric conditions and symptoms—agitation, apathy and depression.

The CDC has released draft guidelines on prescribing opioids for chronic pain days after the National Center for Health Statistics reported a 16.3% jump in opioid overdose-related deaths in 2014. The guidelines, which don’t apply to pain associated with serious diseases or end-of-life care, call for primary care providers to be more conservative when prescribing pain drugs, such as prioritizing physical therapy and other non-opioid treatments. When opioids are needed, prescribers should use the minimum effective dose and short-acting versions of the drugs.

By: Richard Frank, Assistant Secretary for Planning and Evaluation at HHS

New CDC data shows the overall number and rate of drug overdose deaths increased notably between 2013-2014, driven in large part by continued increases in heroin deaths and an emerging increase in deaths involving illicit synthetic opioids. These new data reaffirm that we have not seen the peak of the opioid abuse and overdose epidemic and highlights the need for continued action to prevent opioid misuse and dependence to save lives.

Drug overdose death rates have never been higher. Data shows 18,893 overdose deaths involving opioid pain relievers in 2014, which is an increase of 16%, or 2,658 deaths, compared to 2013 data. Prescription opioid-related overdose deaths are increasing in part because deaths involving synthetic opioids, such as fentanyl and tramadol, increased by 79% from 2013-2014, totaling 5,544 deaths in 2014. Heroin-related deaths have more than tripled since 2010. Heroin-related death rates increased 28% from 2013-2014, totaling 10,574 deaths in 2014. Heroin is often cut with fentanyl – with or without the user’s knowledge – in order to increase its effect.

The opioid epidemic touches all of us. HHS Secretary Sylvia Burwell’s home state of West Virginia, for example, has the highest drug overdose death rate of any state in the country. These statistics reflect what we’re seeing across America, in communities large and small and among people from all walks of life – a rising tide of opioid abuse and overdose.

The U.S. Preventive Services Task Force (USPSTF or Task Force) has released its “Fifth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.”

In 2015, the USPSTF continued to fulfill its mission of improving the health of all Americans by making evidence-based recommendations about clinical preventive services such as screening tests, counseling about healthy behaviors, and preventive medications. These recommendations help primary care clinicians and patients to decide together whether a preventive service is right for each patient’s needs.

In this annual report, the USPSTF has prioritized evidence gaps related to women’s health. Research in these areas would generate much needed evidence for important new recommendations to improve the health and health care of women in the United States.

Variation in the BDNF gene may affect brain’s regulation of appetite, study suggests.

The U.S. Preventive Services Task Force released today a final recommendation statement on screening for abnormal blood glucose and type 2 diabetes mellitus. To view the recommendation and the evidence on which it is based, please go to
http://www.uspreventiveservicestaskforce.org. A fact sheet that explains the final recommendation in plain language is also available. The final recommendation statement can also be found in the October 27, 2015 online issue of Annals of Internal Medicine.

NIH-funded study examines medical, care costs in last five years of life.

By: Jamie Roberts, Gaithersburg, Maryland

I’m a nurse and a patient—and I’m tired of hearing from my doctors that although they know what’s wrong with me, they don’t have many ideas for how to fix it. I was having continuing problems with a gastrointestinal (GI) bleed, and when my doctors suggested a risky procedure as a Hail Mary, I finally asked: “What’s the evidence for it?”

That’s why I’m excited about the Precision Medicine Initiative (PMI), announced by President Obama earlier this year. The core of the initiative is a plan to recruit a 1 million national research group of people, known as a cohort, to provide genetic, environmental and lifestyle data. Researchers will be able to use the data collected to make diagnoses and develop treatments that target individuals’ personal conditions.

Whether or not a treatment for my condition is found, I’m excited about this journey.

The recommendations and opinions of health care professionals play an important role in motivating and encouraging behavior change by their patients. Behavioral counseling interventions (BCIs) to promote healthy behaviors can significantly reduce leading causes of disease and death in the United States such as heart disease, cancer, stroke, diabetes, and lung disease. Recommendations for delivery of these interventions in primary care have been and continue to be an important part of the U.S. Preventive Services Task Force (USPSTF) portfolio of clinical preventive services recommendations. However, research on effective BCIs can be more challenging to understand and integrate into recommendations for primary care than other clinical preventive services such as screening or use of preventive medications. Researching and evaluating the effectiveness of behavioral counseling interventions can also be challenging. AHRQ recently sponsored a special supplement to the September 2015 issue of the
American Journal of Preventive Medicine (AJPM), titled Evidence-Based Behavioral Counseling Interventions as Clinical Preventive Services: Perspectives of Researchers, Funders, and Guideline Developers. The supplement addresses research design and reporting characteristics needed by BCI researchers, and present other perspectives on the evidence needed for integration of BCIs into primary care to include the feasibility dissemination and implementation.

For more information about AHRQ’s Practice Improvement efforts visit the National Center for Excellence in Primary Care Research at http://www.ahrq.gov/professionals/systems/primary-care/index.html.

More patients are getting the right treatment at the right time for their health condition, but progress remains modest for patients with chronic diseases such as diabetes and asthma, according to AHRQ’s recently released
Chartbook on Effective Treatment. Overall, about half of the 46 measures of effective treatment showed improvement. Nine of those measures reached optimal performance, including two related to effective treatment for heart disease—providing percutaneous coronary intervention to heart attack patients within 90 minutes and prescribing certain classes of drugs to treat heart disease upon hospital discharge. Meanwhile, four measures worsened over time, including two measures related to effective management of diabetes and one measure of regular use of medications to prevent asthma attacks. Research summaries for clinicians on management of diabetes and management of heart and blood conditions are available from AHRQ’s Effective Health Care program.

HHS Secretary Sylvia M. Burwell today announced six new members to serve on the Advisory Council on Alzheimer’s Research, Care, and Services. The Council was established in 2011 and convenes quarterly to continue development and progress on the National Plan to Address Alzheimer’s Disease by HHS, Veterans Affairs, the Department of Defense, and the National Science Foundation to address the disease. The new members will replace the members whose terms had expired and those that retired in September and will advise the secretary on federal programs that affect people with Alzheimer’s disease and related dementias, and they will serve overlapping four-year terms.

The American Board of Medical Specialties (ABMS) has announced that it will provide an extra incentive for physicians participating in AHRQ’s EvidenceNOW: Advancing Heart Health in Primary Care initiative. ABMS issued a press release on October 5 noting that physicians who are board certified by one of 20 of the 24 ABMS member boards may now receive maintenance of certification credit for participating in EvidenceNOW. The goal of EvidenceNOW is to help clinicians in small primary care practices systematically implement the latest evidence to help prevent heart attacks and stroke. Through seven regional cooperatives, EvidenceNOW will provide quality improvement services for approximately 1,750 practices with more than 5,000 primary care professionals serving approximately 8 million people.

For more information about AHRQ’s Practice Improvement efforts, visit the National Center for Excellence in Primary Care Research at http://www.ahrq.gov/professionals/systems/primary-care/index.html.

Materials synthesizing valuable insights and lessons learned from three AHRQ-funded grant initiatives on the transformation of primary care practices into patient-centered medical homes (PCMHs) are now available on the
AHRQ Web site: http://www.ahrq.gov/professionals/systems/primary-care/tpc/index.html.

These materials can be used by those considering primary care transformation and those who are interested in understand the primary care transformation process:

• Transforming Primary Care Practice (TPC) grants evaluated the process that primary care practices undergo as they transform into PCMHs. Materials related to this grant initiative include short profiles summarizing each project, a
  journal supplement in the Annals of Family Medicine, an annotated bibliography of the more than 50 peer-reviewed articles resulting from this grant initiative, and a
  summary report synthesizing findings across the 14 grants.
• Estimating the Costs of Supporting Primary Care Practice Transformation grants explored the costs of implementing and sustaining transformative primary care practice redesign, including the direct costs of primary care transformation, such as staff time and equipment, and indirect costs, such as overhead and forgone revenue. Many studies also estimated the costs of attaining and maintaining PCMH recognition. Materials developed for this grant initiative include
  short profiles summarizing each project and a
  practical guide for measuring the costs of primary care transformation.
• Infrastructure for Maintaining Primary Care Transformation (IMPaCT) grants provided funding to State-level initiatives that provided a quality improvement infrastructure for primary care through primary care extension agents. Each of the four “model” IMPaCT States developed collaborations with three or four “partner” States to share the successful infrastructure they had developed. Materials developed for this grant initiative include
  short profiles summarizing key aspects of each project, success stories highlighting unique accomplishments of each grant in its partner States, and a
  summary report.

For more information about AHRQs Practice Improvement efforts visit the National Center for Excellence in Primary Care Research at
http://www.ahrq.gov/professionals/systems/primary-care/index.html.