Personal Digital Assistant for Guideline Adherence Trial

描述（由申请人提供）： 拟议试验的目的是测试一种新的基于实践的干预措施的影响，包括使用基于个人数字助理（PDA）的决策支持，在初级保健实践中遵守复杂的临床实践指南（CPG）。我们选择了成人高血胆固醇检测、评估和治疗专家小组第三次报告（ATP 111）指南，因为它很复杂，包括筛查标准、风险分层和风险组特异性治疗建议。这项随机、对照、基于实践的试验将检验主要假设，即干预实践将使接受适当降脂药物治疗的筛查成人比例净增加。我们将估计该主要终点干预的边际成本效益。其他结局将包括适当1）控制至低密度脂蛋白胆固醇目标，2）筛选，3）风险分层和4）建议改变治疗性生活方式的患者比例。我们将探讨干预对基线观察到的护理差异的影响。干预将在随机化水平（实践）进行，并将包括关于使用基于PDA的决策支持工具的学术细节和培训。所有实践（n=64）将接受常规护理，包括指南传播，基线性能反馈和继续教育。将基于来自基线的患者水平数据和符合胆固醇测量条件的成人患者（N-20，000）的随访图表审查评估结局。将使用适当的方法来分析这些相关数据。将通过对参与医生和工作人员的基线和随访调查进行影响评价。将通过跟踪PDA工具的使用情况进行流程评价。我们估计，在美国，如果充分提高对ATPIII的依从性，每年可以避免多达48，000起重大CHD事件。如果这种干预取得成功，电子决策支持工具可用于促进其他复杂的中央方案的实施。因此，这一创新战略通过预防心血管疾病并随后转化为其他重要疾病，对公共卫生产生重大影响具有很大的希望。

DESCRIPTION (provided by the applicant): The goal of the proposed trial is to test the impact of a novel practice-based intervention, including the use of personal digital assistant (PDA) based decision support, on adherence with a complex clinical practice guideline (CPG) in primary carepractices. We have chosen the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP 111) guideline as it is complex, including screening criteria, risk stratification, and risk-group specific treatment recommendations. This randomized, controlled practice-based trial will test the primary hypothesis that intervention practices will have a net increase in the proportion of screened adults that is treated appropriately with lipid-lowering drug therapy. We will estimate the marginal cost effectiveness of the intervention for this primary endpoint. Other outcomes will include the proportions of patients that is appropriately 1) controlled to low density lipoprotein cholesterol goal, 2) screened, 3) risk-stratified, and 4) counseled regarding therapeutic lifestyle changes. We will explore the intervention effect on disparities in care observed at baseline. The intervention will be delivered at the level of randomization (the practice) and will include academic detailing and training on use of the PDA-based decision support tool. All practices (n=64) will receive usual care, consisting of guideline dissemination, baseline performance feedback, and continuing education. Outcomes will be assessed based on patient level data from baseline and follow-up chart reviews of adult patients (N-20,000) eligible for cholesterol measurement. Appropriate methods will be used to analyze these correlated data. Impact evaluation will be conducted via baseline and follow-up surveys of participating physicians and staff. Process evaluation will be conducted by tracking use of the PDA-based tool. We estimate as many as 48,000 major CHD events could be averted annually in the US with sufficiently improved adherence to ATPIII. If this intervention is successful, electronic decision support tools could be used to facilitate implementation of other complex CPGs. Hence, this innovative strategy holds great promise for making a substantial public health impact through the prevention of CVD and through subsequent translation to other important conditions.