Achieving Outstanding Cardiovascular Health Outcomes for All Ohioans: a Statewide Cardiovascular Health Collaborative (Cardio-OH)

项目摘要 可改变的心血管疾病（CVD）风险因素，如高血压、胆固醇和 吸烟对CVD发病率、死亡率和卫生保健费用有很大影响。俄亥俄州位于 CVD发病率和死亡率的最高四分位数，在CVD风险方面存在显著差异 按地理区域、种族/民族和保险类型划分的因素， 改进的机会。我们建议使用一种独特的促进共同设计的方法， 基于以患者为中心的结果研究（PCOR）制定心脏健康QI干预措施 在扩大的全州俄亥俄州心血管健康协作（Cardi-OH）的背景下， 加快全州CVD改善和减少差距。该提案基于 区域QI优势的口袋，以发展更大，更广泛和可持续的外部QI 支持基础设施，将3个区域健康改善协作组织和7个 医学院在初级保健中有更大的覆盖面和扩展，并与我们的 全州协作组织俄亥俄州心血管健康协作组织。 这个为期三年的项目有三个目标。对于目标1，我们建议扩大一个新生的全州范围 心血管健康协作，建立可持续的外部QI支持 基础设施演进对于目标2，我们将共同设计，实施和评估有效性，采用， 实施和维持整体和亚组的心脏健康气干预 (e.g.,地理、保险、种族/民族）使用组随机化阶梯楔形设计。 对于目标3，我们将确定患者、提供者、诊所和其他相关的背景因素 随着心脏健康QIP诊所的心血管护理和结果的改善， 我们将进行一个强大的混合方法评估：1）Cardi-OH的演变，网络 发展，传播和可持续性; 2）共同设计，采用，实施， 总体和亚组心脏健康QIP的维持和有效性;以及3） 与CVD风险因素过程改进的临床表现更好相关的因素。 项目结果将对政策制定者、健康保险公司、实践管理者、健康管理者和健康管理者有用。 医护人员和病人。这个项目可以提供一个变革性的和可持续的 全州心血管健康改善和减少差距的模式，通过 我们的混合方法评估，可以广泛分享复制。

Project Summary Modifiable cardiovascular disease (CVD) risk factors such as hypertension, cholesterol and smoking contribute strongly to CVD morbidity, mortality, and health care cost. Ohio is in the highest quartile for CVD morbidity and mortality and has significant disparities in CVD risk factors by geographic region, race/ethnicity, and insurance type demonstrating substantial opportunity for improvement. We propose using a unique facilitated co-design approach to develop a heart healthy QI intervention based on patient-centered outcomes research (PCOR) in the context of an expanded statewide Ohio cardiovascular health collaborative (Cardi-OH) to accelerate statewide CVD improvement and reductions in disparities. This proposal builds on pockets of regional QI strengths to develop a larger, more extensive and sustainable external QI support infrastructure by linking the 3 Regional Health Improvement Collaboratives and 7 medical schools with greater reach and extension within primary care and linked to our statewide collaborative, the Ohio Cardiovascular Health Collaborative. This 3-year project has 3 aims. For Aim 1, we propose to expand a nascent statewide cardiovascular health collaborative and establish a sustainable external QI support infrastructure. For Aim 2 we will co-design, implement and evaluate the effectiveness, adoption, implementation, and maintenance of the heart healthy QI intervention overall and by subgroup (e.g., geography, insurance, race/ethnicity) using a group randomized stepped wedge design. And for Aim 3, we will determine patient, provider, clinic, and other contextual factors associated with greater improvements in cardiovascular care and outcomes at the heart healthy QIP clinics We will conduct a robust mixed methods evaluation of: 1) Cardi-OH’s evolution, network development, dissemination, and sustainability; 2) the co-design, adoption, implementation, maintenance and effectiveness of the heart healthy QIP overall and by subgroup ; and 3) the factors associated with better clinical performance on CVD risk factor process improvement. Project findings will be useful to policymakers, health insurers, practice managers, health care providers, and patients. This project could provide a transformative and sustainable statewide model for cardiovascular health improvement and disparity reduction which, through our mixed methods evaluation, can be shared broadly for replication.