Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial.
Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial.
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DOI：
10.1186/s12913-023-09533-1
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发表时间：
2023-05-31
影响因子：
2.8
通讯作者：
Wu, Winfred Y.
中科院分区：
文献类型：
--
作者：
Shelley, Donna R.;Brown, Dominique;Cleland, Charles M.;Pham-Singer, Hang;Zein, Dina;Chang, Ji Eun;Wu, Winfred Y.
关键词：
治疗高血压 (HTN) 已有完善的指南，但只有一半的高血压患者达到 < 140/90 的既定目标。基于团队的护理 (TBC) 是一种改善血压 (BP) 管理和控制的循证策略。 TBC 被定义为由至少两名卫生专业人员提供卫生服务，“他们与患者及其护理人员合作，以实现共同目标，以实现协调、高质量的护理”。然而，初级保健实践在实施 TBC 原则和护理流程方面遇到了挑战；这些在小型独立实践环境（SIP）中更为明显。实践促进 (PF) 是一种实施策略，可以克服采用基于证据的 TBC 来改善 SIP 中的 HTN 管理的障碍。使用阶梯式楔形随机对照试验设计，我们将测试 PF 对纽约市小型诊所（< 5 FTE 临床医生）采用 TBC 改善高血压管理的影响，以及与常规护理相比对血压控制的影响。我们将招募 90 个 SIP，并将它们随机分为三个为期 12 个月的干预波之一。实践促进者将支持 SIP 采用 TBC 原则，以改进五项 HTN 管理策略（即小组管理、人口健康、测量血压、支持药物依从性、自我管理）的实施。主要成果是采用 TBC 进行 HTN 管理，并在基线和 12 个月内进行测量。次要结果包括血压控制率以及 TBC 和 18 个月时血压结果的可持续性。所有集群中的血压测量汇总数据每 6 个月收集一次，以便每个集群提供控制和干预条件下的数据点。使用混合方法，我们还将探讨在组织和团队层面影响 PF 有效性的因素。这项研究将为如何在独立初级保健机构中优化 TBC 的采用和可持续性提供急需的指导，以减轻与次优血压控制相关的疾病负担，并加深对如何促进循证干预措施实施的理解。临床试验.gov； NCT05413252。在线版本包含可在 10.1186/s12913-023-09533-1 获取的补充材料。
There are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target of < 140/90. Team-based care (TBC) is an evidence-based strategy for improving blood pressure (BP) management and control. TBC is defined as the provision of health services by at least two health professionals “who work collaboratively with patients and their caregivers to accomplish shared goals to achieve coordinated, high-quality care”. However, primary care practices experience challenges to implementing TBC principles and care processes; these are more pronounced in small independent practice settings (SIPs). Practice facilitation (PF) is an implementation strategy that may overcome barriers to adopting evidence-based TBC to improve HTN management in SIPs. Using a stepped wedge randomized controlled trial design, we will test the effect of PF on the adoption of TBC to improve HTN management in small practices (< 5 FTE clinicians) in New York City, and the impact on BP control compared with usual care. We will enroll 90 SIPs and randomize them into one of three 12-month intervention waves. Practice facilitators will support SIPs to adopt TBC principles to improve implementation of five HTN management strategies (i.e., panel management, population health, measuring BP, supporting medication adherence, self-management). The primary outcome is the adoption of TBC for HTN management measured at baseline and 12 months. Secondary outcomes include the rate of BP control and sustainability of TBC and BP outcomes at 18 months. Aggregated data on BP measures are collected every 6 months in all clusters so that each cluster provides data points in both the control and intervention conditions. Using a mixed methods approach, we will also explore factors that influence the effectiveness of PF at the organization and team level. This study will provide much-needed guidance on how to optimize adoption and sustainability of TBC in independent primary care settings to reduce the burden of disease related to suboptimal BP control and advance understanding of how facilitation works to improve implementation of evidence-based interventions. ClinicalTrials.gov; NCT05413252. The online version contains supplementary material available at 10.1186/s12913-023-09533-1.
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影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
DOI：
10.3122/jabfm.2018.04.170360
发表时间：
2018-07-01
影响因子：
2.9
作者：
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通讯作者：
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影响因子：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Zhong, Wei
影响因子：
1.4
作者：
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通讯作者：
Shelley, Donna