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

项目摘要 高血压（HTN）是美国最普遍的心血管疾病（CVD）可改变的危险因素 成年人了有完善的指导方针管理HTN，但HTN仍然治疗不足。有 HTN护理指南未充分采用的原因，包括对指南的怀疑 建议，认为患者不依从药物治疗，以及缺乏促进 HTN管理的最佳实践。团队护理（TBC）有可能克服这些障碍。 TBC是由至少两个健康提供者合作提供的健康服务， 通过加强质量改进（QI）基础设施来支持护理， 协调、人口管理、自我管理支持、坚持服药和护理的连续性。 大量研究表明，TBC是一种基于证据的改善血压的策略 (BP)管理和控制。尽管TBC的有效性，初级保健实践经验显着 实施TBC护理流程的障碍。这是特别真实的中小型独立 初级保健实践（SIP），一组未充分研究的实践，代表了大多数门诊护理 提供服务，但往往缺乏资源和当地专门知识来执行符合 待定。 外部实践促进（PF），支持实施循证护理模式的战略， 常规做法，可能会减少在SIP中采用TBC的障碍。然而，缺乏关于 PF对一般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，以改善BP管理为中心， 结果在SIP，以常规护理。在这项研究中，PF实施战略将通过混合开发 方法形成性评估和代表性利益攸关方咨询委员会的投入。这个PF 然后将在90名独立的小学生中进行一项阶梯式楔形分组随机对照试验， 在纽约市的护理实践中，PF对采用TBC（主要结局）和血液 将压力控制（次要结局）与常规护理进行比较。 考虑到血压升高带来的公共卫生负担，实施TBC作为一种基于证据的方法， 改善血压控制的实践对改善CVD结果具有巨大潜力。这项研究将提供许多- 需要指导如何在独立的初级保健环境中优化TBC的采用和可持续性， 实现改进HTN管理的潜力，并解决现有研究中的差距。

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.