Research Spotlight: ESCALATES

Changing How We Prevent Heart Disease

03/17/16  Portland, Ore.

ESCALATES photoOHSU Family Medicine at the Heart of Primary Care Quality Initiative

Heart disease is one of America's biggest public health threats, standing as the nation's leading cause of death and killing more than 600,000 Americans every year.

Yet, as startling and daunting as those statistics are, the fact is that heart disease is preventable with some relatively simple physical and behavioral changes. That's why the Agency for Healthcare Research and Quality (AHRQ), has granted funding for national research and evaluation centered on cardiac health intervention where most Americans seek care: the primary care clinic. And Oregon Health & Science University Department of Family Medicine (OHSU) is excited to be at the center of the effort.

The AHRQ project seeks to improve the ABCS of heart health: aspirin use, blood pressure control, cholesterol and smoking cessation. There are two components within AHRQ's project, called EvidenceNOW: seven regional cooperatives and a national evaluation, called ESCALATES (Evaluating System Change to Advance Learning and Take Evidence to Scale). Each of the seven cooperatives, is made up of 200 to 300 small primary care practices working the front lines of healthcare. These seven cooperatives provide their 1,500-plus participating clinics –most of which have less than 10 clinicians - with ABCS implementation support, including on-site facilitation, electronic health record assistance and other resources previously out of reach for clinics of their size, or in their rural locations.

ESCALATES is led by Deborah Cohen, PhD, Associate Professor in the Department of Family Medicine at OHSU. Working with a team of 13 other OHSU staffers, (see sidebar) and many national co-investigators including Bijal Balasubramanian, MBBS, PhD, Benjamin Crabtree, PhD, and Leif Solberg, MD among others, are charged with a national evaluation of EvidenceNOW. Put simply, ESCALATES is about quantitative and qualitative data analysis to answer the questions, "What worked?" and, equally important, "What didn't?"

Using qualitative and quantitative data, ESCALATES is working to ensure that successful interventions and supports are generalizable and scalable for all clinics, not just those participating in EvidenceNOW. ESCALATES also has an aggressive and broad dissemination plan for its evidence-based findings, offering the key information clinics, cooperatives, researchers, and other stakeholders need to help fuel systemic change.

The study began in May 2015 and is scheduled to wrap up in 2019. ESCALATES recently launched its new website, to provide a hub of dynamic, comprehensive information about EvidenceNOW and ESCALATES. The national project team, made up of cross-functional committees from other research and academic organizations around the country, gathered in Corbett, OR, for a three-day working retreat in February to celebrate milestones and set the course for the coming year's work and priorities.

"This study is pioneering in so many ways," says Cohen. "The sheer numbers of participating clinics, the broad geography and wide range of participating stakeholders are just some of the ways this work is cutting edge. We are honored and excited to be part of EvidenceNOW."


ESCALATES: Facts & Figures

ESCALATES is an ambitious, nationwide evaluation of quantitative and qualitative data gathered from EvidenceNOW, an AHRQ-driven initiative. The large-scale project, the first of its kind, is focused on small primary care clinics and their ability to help their patients avoid American's No. 1 cause of death: heart disease. Several OHSU staff members have crucial roles in the ESCALATES project:

Deborah Cohen, PhD, principal investigator
John McConnell, PhD, lead economist
Tomi Mori, PhD, steering committee member
Miguel Marino, PhD, lead biostatistician
Sarah Ono, PhD, qualitative co-lead
Stephan Linder, PhD, economist
Eve Dexter, MS, biostatistician Marie Killerby, MPH, biostatistician
Jen Hall, MPH, analyst
David Cameron, analyst
Marissa Fuqua-Miller, research assistant
Rose Gunn, MA, methods project manager
Claire Diener, communications project manager
Leah Gordon, MPH, project director