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

项目摘要 在美国，高血压(HTN)是心血管疾病(CVD)最普遍的可改变的危险因素。 成年人。管理HTN有完善的指导方针，但HTN仍未得到充分对待。有一种 未充分采用HTN护理指南的一些原因，包括对指南的怀疑 建议，认为患者不遵守药物治疗的看法，以及缺乏促进的系统 HTN管理方面的最佳实践。基于团队的护理(TBC)具有克服这些障碍的潜力。 TBC是由至少两个健康提供者提供的健康服务，他们共同努力，以改善 通过加强质量改进(QI)基础设施来支持护理来管理慢性病 协调、人口管理、自我管理支持、坚持用药和护理的连续性。 大量研究表明，TBC是一种基于证据的改善血压的策略 (BP)管控。尽管TBC有效，但初级保健实践经历了显著的 实施TBC护理流程的障碍。对于中小型独立公司来说，情况尤其如此 初级保健实践(Sips)，代表大多数门诊护理的一组未得到充分研究的实践 交付，但往往缺乏资源和当地专业知识来实施符合以下条件的护理流程 TBC。 外部实践促进(PF)，这是一项支持实施循证护理模式的战略 常规做法，可能会减少在sips中采用TBC的障碍。然而，关于这方面的文献却很匮乏。 PF对TBC普遍采用的影响，特别是在sips中的影响。这项研究的目的是比较 PF在采用TBC核心组件方面的有效性，重点是改善BP管理和 SIPS的结果，到通常的护理。在这项研究中，将通过MIXED来制定PF的实施策略 方法形成性评估和来自具有代表性的利益相关者咨询委员会的投入。这个PF 然后将在90名独立小学的阶梯式楔形群随机对照试验中对该策略进行评估 纽约市的护理实践中，PF对采用TBC(主要结局)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BP升高带来的公共卫生负担，TBC的实施是一种循证的 改善血压控制的做法对改善心血管疾病的预后具有巨大的潜力。这项研究将提供更多- 需要关于如何在独立的初级保健环境中优化TBC的采用和可持续性的指导 认识到改进HTN管理的潜力，并解决当前先前研究中的差距。

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.