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Implementing Shared Decision Making (SDM) for Individualized CV Prevention (SDM4IP)

实施共享决策 (SDM) 以实现个体化心血管预防 (SDM4IP)

基本信息

批准号：
10392952
负责人：
VICTOR MANUEL MONTORI
金额：
$ 65.54万
依托单位：
MAYO CLINIC ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10392952
关键词：
Address Adoption Adult American American Heart Association Attitude Cardiology Cardiovascular Diseases Cardiovascular system Caring Clinic Visits Cluster randomized trial Consolidated Framework for Implementation Research Disease Management Effectiveness Emotional Ensure Evaluation Event Evidence based intervention Exercise Face Fostering Goals Guidelines Health system Human Hybrids Individual Interdisciplinary Study Intervention Life Life Style Light Medical Medicine Methods Morbidity - disease rate Myocardial Infarction Organizational Policy Outcome Patient-Centered Care Patients Persons Pharmaceutical Preparations Pharmacology Practice Guidelines Prevention Preventive Preventive treatment Primary Health Care Primary Prevention Process Public Policy Quality of life Randomized Reach Effectiveness Adoption Implementation and Maintenance Recommendation Regimen Reporting Resources Risk Stroke Target Populations Time Translating Work analog blind cardiovascular risk factor clinical encounter clinical practice college cost design effectiveness evaluation effectiveness implementation study evidence base experience glucagon-like peptide 1 high risk implementation evaluation implementation framework implementation outcomes implementation science implementation strategy improved individual patient inhibitor innovation mortality multidisciplinary preference prevent preventive intervention primary care setting psychosocial randomized trial research data dissemination routine care routine practice shared decision making theories tool treatment as usual treatment planning trend uptake

项目摘要

PROJECT SUMMARY/ABSTRACT The primary prevention of cardiovascular (CV) events is often more intense in individuals at lower risk and vice versa (risk-treatment paradox) in part due to unawareness of each person’s CV risk, of their preferences for prevention interventions, and of their feasibility in each person’s daily life. Extant practice guidelines recommend that clinicians and patients work together to arrive at an effective and feasible prevention plan that is congruent with each person’s CV risk and informed preferences, a process called shared decision making (SDM). An effective and innovative tool that estimates CV risk and shows the impact and features of available lifestyle and pharmacological preventive interventions for use during the clinical encounter to enable SDM, the CV Prevention Choice tool, is available yet remains rarely used in practice. Our broad goal is to promote patient-centered care that effectively reduces the substantial burden of CV disease among Americans. This study, directly responsive to PA-19-166, seeks to identify implementation approaches that foster routine SDM about primary CV prevention in a diverse set of primary care practices across the U.S. This 5-year study – proposed by a multidisciplinary team with expertise in preventive cardiology, SDM, and implementation science – will draw on an implementation framework (Consolidated Framework for Implementation Research), an implementation theory (Normalization Process Theory), and an evaluation framework (RE-AIM) to design, conduct, and report a mixed method, hybrid implementation- effectiveness (Type III), stepped-wedge clustered randomized trial to determine: - Implementation effectiveness (Aim 1) by evaluating practice contexts and engagement of users in implementation strategies, implementation outcomes (e.g., reach, adoption) associated with these strategies, and how implementation fosters routine adoption of SDM and the CV Prevention Choice tool in primary care practices, and - SDM effectiveness (Aim 2) estimated by the extent to which individual CV prevention plans are feasible and congruent with each person’s estimated CV risk and preferences. By the project’s end, we expect to have (a) identified the most effective implementation strategies to embed SDM in routine practice and (b) estimated the effectiveness of SDM to achieve feasible and risk-concordant CV prevention in primary care.

项目概要/摘要心血管 (CV) 事件的一级预防通常在个体中更为强烈风险较低，反之亦然（风险治疗悖论），部分原因是不了解每个人的风险 CV 风险、他们对预防干预措施的偏好以及每个人的可行性日常生活。现有的实践指南建议临床医生和患者共同努力制定适合每个人的心血管风险的有效且可行的预防计划和知情偏好，这个过程称为共享决策（SDM）。一个有效且评估心血管风险并显示现有生活方式的影响和特征的创新工具以及在临床遇到时使用的药物预防干预措施，以便能够 SDM（CV 预防选择工具）已可用，但在实践中仍很少使用。我们的总体目标是促进以患者为中心的护理，有效减少大量的医疗费用美国人的心血管疾病负担。这项研究直接响应 PA-19-166，旨在确定促进关于初级心血管预防的常规 SDM 的实施方法这项为期 5 年的研究——由美国各地的不同初级保健实践机构提出多学科团队拥有预防心脏病学、SDM 和实施科学方面的专业知识 – 将利用实施框架（综合实施框架研究）、实施理论（标准化过程理论）和评估框架（RE-AIM）来设计、实施和报告混合方法、混合实施- 有效性（III 型），阶梯楔形聚类随机试验以确定： - 通过评估实践背景和参与度来实现实施有效性（目标 1）实施策略中的用户、实施结果（例如覆盖面、采用率）相关这些策略的实施，以及实施如何促进 SDM 和 CV 的常规采用初级保健实践中的预防选择工具，以及 - 通过个人心血管预防计划的程度来估计 SDM 有效性（目标 2）是可行的，并且与每个人估计的心血管风险和偏好一致。到项目结束时，我们期望 (a) 确定最有效的实施方案将 SDM 嵌入日常实践的策略，以及 (b) 评估 SDM 的有效性在初级保健中实现可行且风险一致的心血管预防。