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Prevention and Chronic Care

The mission of AHRQ's Prevention and Chronic Care Program is to improve the quality, safety, efficiency, and effectiveness of evidence-based preventive and chronic care services. This work is accomplished in many ways:

  • By providing researchers, clinicians, and decisionmakers with access to evidence-based resources.
  • By funding research activities to improve primary care and clinical outcomes.
  • By publishing research findings in scientific peer-reviewed journals.
  • By holding meetings to help transfer knowledge between stakeholders.
  • By creating products and resources that target priority populations (such as minorities or uninsured patients) and conditions.
  • By making and maintaining strategic partnerships that advance a shared mission.
  • By developing effective tools for primary care practices.

The Prevention and Chronic Care Program comprises two overall project areas: improving primary care practice and helping with evidence-based decisionmaking.

Improving Primary Care Practice

AHRQ utilizes the Institute of Medicine Exit Disclaimer definition of primary care, which recognizes that primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care is the foundation of the U.S. health care system, and is by some measures its largest part. In 2008, 490 million visits were made to primary care physicians—a bit more than half of all visits to physicians' offices. Good access to primary care is associated with more timely care, better preventive care, avoiding unnecessary care, less costs, and fewer deaths.

In this section you will find information about the work that AHRQ is doing to improve primary care practice. The following links will take you to other resources that provide more detail about our work and provide you with valuable resources and information that relates to primary care.

Care Coordination. Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. This means that the patient's needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient.

Clinical-Community Linkages. Clinical-community linkages help to connect health care providers, community organizations, and public health agencies so they can improve patients' access to preventive and chronic care services.

Health Care/System Redesign. Health care/system redesign involves making systematic changes to primary care practices and health systems to improve the quality, efficiency, and effectiveness of patient care.

Health Information Technology Integration. The integration of health information technology (IT) into primary care includes a variety of electronic methods that are used to manage information about people's health and health care, for both individual patients and groups of patients. The use of health IT can improve the quality of care, even as it makes health care more cost effective.

Behavioral and Mental Health. Many studies have demonstrated that high-quality mental and behavioral health care may often be delivered in primary care settings. Because mental health, behavioral health, and substance use disorders are among the most common conditions seen in primary care settings and frequently occur with other medical problems, primary care providers are often in the best position to identify, diagnose, and treat them. A primary care practice will not reach its full potential without adequately addressing patients' mental health needs. To further research in this area, AHRQ has developed the Academy for Integrating Behavioral Health and Primary Care, which serves as a national resource and coordinating center.

Self-Management Support. Self-management support is the help given to people with chronic conditions that enables them to manage their health on a day-to-day basis. Self-management support can help and inspire people to learn more about their conditions and to take an active role in their health care.

Evidence-Based Decisionmaking

Evidence-based practice is the use of the best available evidence together with a clinician's expertise and a patient's values and preferences in making health care decisions. The Prevention and Chronic Care Program works to expand the available evidence base for evidence-based practice and to ensure clinicians have the tools to put this knowledge base into practice.

Clinical Decision Support. Clinical decision support provides timely information, usually at the point of care, to help inform decisions about a patient's care. Clinical decision support can effectively improve patient outcomes and lead to higher-quality health care.

Multiple Chronic Conditions. As part of its ongoing effort to improve care for patients with multiple chronic conditions (MCC) through evidence-based research, AHRQ has funded the AHRQ MCC Research Network. The Network aligns with a Department of Health and Human Services effort to address MCC issues.

U.S. Preventive Services Task Force. The U.S. Preventive Services Task Force (USPSTF) is an independent, volunteer group of national experts in prevention and evidence-based medicine that makes recommendations about clinical preventive services such as screening tests, counseling services, and preventive medications. AHRQ is authorized by Congress to provide scientific, technical, administrative, and dissemination support to the USPSTF.

Prevention and Chronic Care Announcements

To see a list of announcements previously sent to AHRQ's Prevention and Chronic Care subscribers, select here. To sign up for Prevention and Chronic Care updates, select here.

Prevention and Chronic Care Resources

AHRQ works to improve the delivery of preventive care by developing tools, resources, and materials to support health care organizations and engage the entire health care delivery system. The following is a list of AHRQ resources relevant to prevention and chronic care.

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