Facilitation of Team-based Care to Improve HTN Management and Outcomes

促进基于团队的护理，以改善 HTN 管理和结果

• 批准号: 10523874
• 负责人: Donna R Shelley
• 金额: $ 69.5万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10523874
• 关键词: Facilitation; Team; based; Care; Improve

Project Summary Hypertension (HTN) is the most prevalent modifiable risk factor for cardiovascular disease (CVD) among U.S. adults. There are well-established guidelines for managing HTN, yet HTN remains undertreated. There are a number of reasons for inadequate adoption of HTN care guidelines, including skepticism about guideline recommendations, perceptions that patients are non-adherent to medications, and lack of systems to facilitate best practices in HTN management. Team based care (TBC) has the potential to overcome these barriers. TBC is the provision of health services by at least two health providers who work collaboratively to improve chronic disease management through enhancements in quality improvement (QI) infrastructure to support care coordination, population management, self-management support, medication adherence and continuity of care. Numerous studies have demonstrated that TBC is an evidence-based strategy for improving blood pressure (BP) management and control. Despite the effectiveness of TBC, primary care practices experience significant barriers to implementing TBC care processes. This is particularly true for small-medium size independent primary care practices (SIPs), an understudied group of practices that represent the majority of outpatient care delivery but which often lack the resources and local expertise to implement care processes consistent with TBC. External practice facilitation (PF), a strategy to support implementation of evidence-based models of care into routine practice, may mitigate barriers to adoption of TBC in SIPs. Yet, there is a dearth of literature on the effect of PF on adoption of TBC in general and specifically in SIPs. The objective of this study is to compare the effectiveness of PF on the adoption of core TBC components, centered on improving BP management and outcomes in SIPs, to usual care. In this study, a PF implementation strategy will be developed through mixed methods formative assessment and input from a representative stakeholder advisory committee. This PF strategy will then be evaluated in a stepped wedge cluster randomized control trial in 90 independent primary care practices in New York City where the effect of PF on adoption of TBC (primary outcome) and blood pressure control (secondary outcome) will be compared against usual care. Given the public health burden that elevated BP presents, implementation of TBC as an evidence-based practice to improve BP control has great potential to improve CVD outcomes. This study will provide much- needed guidance on how to optimize adoption and sustainability of TBC in independent primary care setting to realize the potential of improved HTN management and addresses current gaps in prior research.

项目概要 高血压 (HTN) 是美国最常见的心血管疾病 (CVD) 可改变危险因素 成年人。对于高血压的管理已有完善的指南，但高血压的治疗仍然不足。有一个 未充分采用高血压护理指南的多种原因，包括对指南的怀疑 建议、认为患者不坚持服药的看法以及缺乏促进的系统 HTN 管理的最佳实践。基于团队的护理 (TBC) 有可能克服这些障碍。 TBC 是指由至少两名卫生服务提供者提供卫生服务，他们合作以改善 通过增强质量改进 (QI) 基础设施来支持护理的慢性病管理 协调、人口管理、自我管理支持、药物依从性和护理的连续性。 大量研究表明，TBC 是一种基于证据的改善血压策略 （BP）管理和控制。尽管 TBC 很有效，但初级保健实践仍然存在重大问题 实施 TBC 护理流程的障碍。对于中小型独立企业来说尤其如此 初级保健实践 (SIP)，代表大多数门诊护理的一组未经研究的实践 交付，但往往缺乏资源和当地专业知识来实施与 待定。 外部实践促进（PF），一种支持实施循证护理模式的策略 常规实践，可以减少在 SIP 中采用 TBC 的障碍。然而，相关文献却十分匮乏 PF 对 TBC 采用的影响，特别是在 SIP 中。本研究的目的是比较 PF 在采用核心 TBC 组件方面的有效性，重点是改进 BP 管理和 SIP 的结果，到常规护理。在本研究中，将通过混合方式制定 PF 实施策略 方法形成性评估和代表性利益相关者咨询委员会的意见。这个PF 然后，将在 90 名独立主要参与者的阶梯式楔形集群随机对照试验中对策略进行评估 纽约市的护理实践中 PF 对采用 TBC（主要结果）和血液的影响 压力控制（次要结果）将与常规护理进行比较。 鉴于血压升高带来的公共卫生负担，实施 TBC 作为基于证据的 改善血压控制的实践对于改善心血管疾病的结果具有巨大的潜力。这项研究将提供很多—— 需要关于如何在独立初级保健环境中优化 TBC 的采用和可持续性的指导，以 认识到改进 HTN 管理的潜力并解决先前研究中的当前差距。

项目成果

Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial.

• DOI: 10.1186/s12913-023-09533-1
• 发表时间: 2023-05-31
• 期刊: BMC HEALTH SERVICES RESEARCH
• 影响因子: 2.8
• 作者: Shelley, Donna R.;Brown, Dominique;Cleland, Charles M.;Pham-Singer, Hang;Zein, Dina;Chang, Ji Eun;Wu, Winfred Y.
• 通讯作者: Wu, Winfred Y.