MEDication Focused Outpatient Care for Underutilization of Secondary Prevention

以医疗为重点的门诊护理未充分利用二级预防

• 批准号: 9042420
• 负责人: CHRISTOPHER S. COFFEY
• 金额: $ 205.67万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9042420
• 关键词: Address; Adherence; Adoption; African American; Ambulatory Care; American; Attitude; Belief; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical Pharmacists; Cluster randomized trial; Control Groups; Cost Effectiveness Analysis; Diffuse; Disease Management; Enrollment; Event; Goals; Guideline Adherence; Guidelines; Health; Health system; Home environment; Intervention; Lead; Literature; Managed Care; Medical; Meta-Analysis; Modeling; Myocardial Infarction; Online Systems; Outcome; Patients; Pharmaceutical Preparations; Pharmacists; Physicians; Prevention trial; Primary Health Care; Provider; Randomized; Research; Risk Factors; Secondary Prevention; Self Management; Services; Stroke; Testing; Underrepresented Minority; United States; Visit; base; cardiovascular disorder prevention; cardiovascular risk factor; care delivery; care systems; cost; cost effectiveness; effective care management; ethnic diversity; group intervention; health record; improved; innovation; mortality; novel strategies; patient oriented; prevent; racial diversity; racial minority; social norm; treatment as usual; treatment strategy

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) causes 2,200 deaths in Americans every day with one death every 39 seconds. There is evidence that these deaths can be prevented with better risk factor management, however, many risk factors remain uncontrolled. The Patient-Centered Medical Home (Medical Home) which includes self-management, personalized health records and team-based care, has been proposed as a strategy to reduce these gaps in care delivery. Several Cochrane reviews and meta-analyses have found evidence that adding pharmacists to the primary care team improves risk factor control and physician adherence to guidelines. Managed care organizations have found that a centralized cardiovascular risk service (CVRS) managed by pharmacists can reduce mortality. It is not known if a comprehensive CVRS model would be implemented in typical office practices and this lack of evidence is a major gap in the literature. The objective of this application is t conduct a multi-center, cluster-randomized study utilizing a centralized CVRS in medical offices with large geographic, racial and ethnic diversity to determine the extent to which the CVRS model will be implemented. We will randomize 16 primary care offices to the CVRS or usual care and enroll 400 subjects of which 220 subjects will be from racial minorities. We will also select 25 patients per office (n=400, total n=800) into a passive observation group which will allow us to determine the extent to which the intervention diffuses more broadly for unexposed patients. Our central hypothesis is that a centralized CVRS managed by clinical pharmacists will be implemented and significantly improve CVD guideline adherence using the Guideline Advantage metrics. The rationale for this proposed study is that implementation of a novel strategy to improve secondary prevention of CVD will lead to innovative strategies for broader adoption by health systems throughout the US. We will accomplish our objectives and test our central hypothesis with the following specific aims: Our primary Aim is: To determine if a web-based CVRS managed by clinical pharmacists will be implemented within diverse primary care offices. We postulate that adherence to guidelines for secondary prevention of CVD will be significantly greater in patients from clinics randomized to the centralized CVRS group compared to the control group. This study is expected to produce the following outcomes: guideline adherence will be 40% at baseline and increase to at least 60% in the intervention group at 12 months. We expect guideline adherence will deteriorate after the intervention is discontinued but will remain significantly higher than the control group.

描述（由申请人提供）：心血管疾病 (CVD) 每天导致 2,200 美国人死亡，其中每 39 秒就有 1 人死亡。有证据表明，通过更好的风险因素管理可以预防这些死亡，但是，许多风险因素仍然不受控制。以患者为中心的医疗之家（医疗之家）包括自我管理、个性化健康记录和基于团队的护理，已被提议作为缩小护理服务差距的战略。多项 Cochrane 综述和荟萃分析发现证据表明，将药剂师加入初级保健团队可以改善风险因素控制和医生对指南的遵守。管理式医疗组织发现，由药剂师管理的集中心血管风险服务 (CVRS) 可以降低死亡率。目前尚不清楚综合的 CVRS 模型是否会在典型的办公室实践中实施，而证据的缺乏是文献中的一个主要空白。 此应用程序的目标是在地理、种族和民族多样性较大的医疗办公室中利用集中式 CVRS 进行多中心、集群随机研究，以确定 CVRS 模型的实施程度。我们将把 16 个初级保健办公室随机分配到 CVRS 或常规保健中心，并招募 400 名受试者，其中 220 名受试者来自少数族裔。我们还将在每个办公室选择 25 名患者（n = 400，总共 n = 800）进入被动观察组，这将使我们能够确定干预措施对未暴露患者更广泛扩散的程度。我们的中心假设是，将实施由临床药剂师管理的集中式 CVRS，并使用指南优势指标显着提高 CVD 指南的遵守率。这项拟议研究的理由是，实施一项改善心血管疾病二级预防的新策略将导致美国各地卫生系统更广泛采用创新策略。我们将实现我们的目标并通过以下具体目标检验我们的中心假设： 我们的主要目标是：确定由临床药剂师管理的基于网络的 CVRS 是否将在不同的初级保健办公室内实施。我们假设，与对照组相比，来自随机分配到集中 CVRS 组的诊所的患者对 CVD 二级预防指南的遵守率将显着更高。 这项研究预计将产生以下结果：基线时指南的遵守率将达到 40%，并在 12 个月时干预组的遵守率将增加到至少 60%。我们预计干预停止后指南依从性会恶化，但仍显着高于对照组。