Translating ATP III Cholesterol Management Guidelines *

描述(由申请人提供)： 该项目将演示和评估将ATPIII胆固醇管理指南转化为初级保健实践的情况。在第一阶段，需求评估将通过初级保健患者和提供者的重点小组，评估将ATPIII指南实施到临床实践的障碍和促进者。利用形成性评估和对患者和提供者的半结构化个人访谈的反馈，以及在10个初级保健实践的试点测试期间的参与者观察，将改进和定制三个工具：基于NHLBI基于网络的10年CHD风险评分的计算机化患者激活工具，将放置在每个初级保健办公室的候诊室供患者使用；ATP III手持设备(PDA)互动指南工具，将由初级保健提供者用作护理点的决策支持工具；以及学术详细材料，包括实践手册、互动、PowerPoint幻灯片和在学术详细介绍会议期间使用的实践材料。在第二阶段，将在罗德岛州和新英格兰东南部的初级保健实践(24个实践/48个提供者)中进行为期一年的干预，进行随机分组试验，以测试在第一阶段开发的材料的有效性，以改善围绕ATP III指南实施的医生表现，并改善临床相关结果，即低密度脂蛋白-胆固醇患者达到其ATP III目标的百分比。这笔赠款发放的产品将包括焦点小组的结果、实施ATP III指南结果的障碍和促进者、关于ATP III指南的护理质量评估的MedQuest模块、改进的计算机化患者激活工具、针对PDA的定制的ATP III互动指南工具、定制的学术详细材料以及关于这些工具改善初级保健实践有效性的随机临床试验的结果。

DESCRIPTION (provided by the applicant): This project will demonstrate and evaluate the translation of the ATP III Cholesterol management guidelines into primary care practice. During phase 1, a needs assessment will evaluate barriers and facilitators to implementation of ATP III guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from semi-structured individual interviews of patients and providers and participant observation during pilot testing in 10 primary care practices, three tools will be refined and tailored: a computerized patient activation tool based upon NHLBI web-based 10-year CHD risk score that will be placed in each primary care office's waiting room for patient use; an ATP III interactive guidelines tool for hand held device (PDA) to be used by primary care providers as a decision support tool at the point of care and academic detailing materials consisting of a practice manual, interactive, powerpoint slides, and practice materials to be used during a academic detailing session. During phase 2, a block, randomized designed cluster trial will be performed with one year of intervention within primary care practices (24 practices/48 providers) throughout the state of Rhode Island and Southeastern New England to test the effectiveness of the materials developed in phase 1 to improve physician performance around ATP III guideline implementation and to improve clinically relevant outcomes, the percentage of patients with LDL-cholesterol at their ATP III goal. Products for dissemination from this grant will include the results of the focus groups barriers and facilitators to implementation of ATP III guidelines findings, a MedQuest module for quality of care assessment regarding ATP III guidelines, refined computerized patient activation tool, tailored ATP III interactive guideline tool for PDA, tailored academic detailing materials and results of randomized clinical trial on the effectiveness of these tools to improve primary care practice.