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)

• 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
• 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

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.

项目总结/摘要 心血管（CV）事件的一级预防通常在以下个体中更为强烈： 风险较低，反之亦然（风险-治疗悖论），部分原因是没有意识到每个人的 心血管风险，他们对预防干预措施的偏好，以及他们在每个人的 日常生活现有的实践指南建议临床医生和患者共同努力， 制定一个有效可行的预防计划，与每个人的CV风险相一致 和知情的偏好，这一过程称为共享决策（SDM）。有效和 一种创新工具，可估计心血管风险并显示现有生活方式的影响和特征 和药理学预防性干预，用于临床治疗， SDM是CV预防选择工具，但在实践中很少使用。 我们的广泛目标是促进以病人为中心的护理，有效地减少大量的 美国人的CV疾病负担。本研究直接响应PA-19-166，旨在 确定实施方法，促进常规SDM关于一级CV预防， 这项为期5年的研究-由一个 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 - 将利用一个执行框架（综合执行框架 研究）、实施理论（规范化过程理论）和评估 框架（RE-AIM）设计、执行和报告混合方法、混合实施- 有效性（III型），阶梯楔形分组随机试验，以确定： - 通过评价实践背景和参与情况，提高执行效力（目标1） 实施战略、实施成果中的用户（例如，达到，采用）相关 这些战略，以及实施如何促进常规采用SDM和CV 初级保健实践中的预防选择工具，以及 - SDM有效性（目标2）通过个人CV预防计划的程度进行评估 是可行的，符合每个人的估计CV风险和偏好。 到项目结束时，我们预计将：（a）确定最有效的实施办法， 将可持续发展机制纳入日常实践的战略，以及（B）估计可持续发展机制的有效性， 在初级保健中实现可行且风险一致的CV预防。