PRIMARY AND SECONDARY PREVENTION OF CHD AND STROKE

该应用程序的主要目的是研究使用学术细节和电子医疗记录（EMR）的质量改进模型对初级保健机构中预防心血管疾病和中风的临床实践指南的依从性的影响。本研究的长期目标是验证一种将信息工具和行为改变理论相结合的方法在初级保健中实施循证医学的方法。来自南卡罗来纳医科大学卫生保健研究中心（CHCR）的研究人员将在美国22个附属的实践合作伙伴研究网络（pPRNet）站点进行这项研究。在之前的研究中，项目调查人员已经开发并改进了该模型，以便在此应用中进行测试。该模式被称为“通过电子医疗记录（QIT-EMR）提高质量”。研究的一级预防指南将包括高血压筛查和高血压控制、高脂血症筛查以及绝经后女性的激素替代治疗。二级预防指南将包括冠心病（CHD）和糖尿病（DM）患者的降胆固醇，有心肌梗死史患者的β -受体阻滞剂，心力衰竭患者的血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂，心房颤动患者的口服抗凝治疗，糖尿病患者的血糖和血压控制。该研究将是一项为期三年的随机对照临床试验。它将检验这样一个假设，即接受QIT-EMR模型干预的实践比比较实践在接受一级和二级预防干预并达到目标结果的患者比例方面有更大的改善。研究数据将从每个研究实践的现有电子病历中获得。对照组实践将收到有关临床实践指南的信息，以及详细说明其遵守情况的季度报告。干预组实践将收到相同的信息，并参与研究调查员的四次实践现场访问，三次调查员会议和持续的沟通，以实施QIT-EMR模型。将对这些干预措施进行形成性评价。在试验结束时，将评估干预措施的影响和成本。

The principal aim of the application is to study the impact of a quality improvement model using academic detailing and electronic medical records (EMR) on adherence with clinical practice guidelines for prevention of cardiovascular disease and stroke in primary care settings. The long-term objective of the research is to validate a method implementing evidence- based medicine in primary care, using an approach combining information tools and behavioral change theory. Investigators from the Medical University of South Carolina's Center for Health Care Research (CHCR) will conduct the study in 22 affiliated Practice Partner Research Network (pPRNet) sites across the United States. Project investigators have developed and refined the model to be tested in this application in previous research. The model is termed "Quality Improvement through Electronic Medical Records (QIT-EMR)." The primary prevention guidelines studied will be screening for hypertension and hypertension control, screening for hyperlipidemia, and hormone replacement therapy for postmenopausal females. The secondary prevention guidelines will be cholesterol lowering for patients with coronary heart disease (CHD) and diabetes mellitus (DM), beta-blockers for patients with a history of myocardial infarction, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers for patients with heart failure, oral anticoagulant therapy for patients with atrial fibrillation, and glycemic and blood pressure control in patients with DM. The study will be a three-year randomized controlled clinical trial. It will test the hypothesis that practices that receive the QIT-EMR model interventions will have greater improvement in the proportion of patients who receive the primary and secondary preventive interventions and achieve target outcomes than do comparison practices. Data for the study will be obtained from the existing EMR at each study practice. Control group practices will receive information about the clinical practice guidelines, and quarterly reports detailing their adherence with them. Intervention group practices will receive identical information and participate in four practice site visits by study investigators, three investigator meetings, and ongoing communication to implement the QIT-EMR model. A formative evaluation of the interventions will be conducted. At the conclusion of the trial, the impact and cost of the intervention will be assessed.