Facilitation, Spread and Translation of Patient-Centered Evidence in NC Practices

 描述（由申请人提供）：背景：北卡罗来纳州的心血管疾病负担仍然很大。最新数据显示，每年心血管疾病死亡率为每10万人263人，占该州死亡人数的近三分之一。疾病进展主要由几个风险因素决定，包括血压或胆固醇升高，不使用阿司匹林预防，以及吸烟。目前组织的初级保健实践无法使一半以上的患者达到减少风险因素的建议目标。特别是小型独立诊所，缺乏资源来加强实践支持，以改善心血管护理。目的：FAST PACE NC的目标是确定初级保健实践支持是否加速了PCOR调查结果的传播和实施，以改善心脏健康，并提高初级保健实践在未来纳入其他PCOR调查结果的能力。研究方法：FAST PACE NC是一项阶梯楔形、分层、整群随机试验，旨在评价初级保健支持对循证CVD预防和组织变革过程措施的影响。每个实践将作为对照开始试验，在随机时间点接受干预，然后在开始干预后12个月进入维持期。从项目第7个月开始，150个高准备度实践和150个低准备度实践将以交错的方式得到促进，最后一个实践从第16个月开始。所有实践将接受12个月的密集干预，包括现场QI促进，学术细节，EHR支持，并通过北卡罗来纳州健康信息交换，全州范围内的共享实用程序提供整个人口分析，护理差距识别，基准和外部报告机制，否则将无法提供给独立的实践。潜在影响：成功的干预将证明，有效信息学支持的实践促进 工具是将变革和组织振兴方案的结论付诸实践的一种有效方法。在300个实践中，心血管风险明显降低，覆盖估计超过90万成年患者，可能导致在10年内预防数千起心血管事件。

 DESCRIPTION (provided by applicant): Background: The burden of cardiovascular disease in North Carolina remains large. The latest data available show an annual cardiovascular death rate of 263 per 100,000 explaining almost one-third of deaths in the state. Disease progression is largely determined by several risk factors including elevated blood pressure or cholesterol, not using aspirin for prevention, and tobacco use. Primary care practices as currently organized have been unable to get more than half these patients to achieve recommended targets for risk factor reduction. Small independent practices, in particular, lack resources for enhanced practice support to improve cardiovascular care. Objective: The objective of FAST PACE NC is to determine if primary care practice support accelerates the dissemination and implementation of PCOR findings to improve heart health and increases primary care practices' capacity to incorporate other PCOR findings in the future. Methods: FAST PACE NC is a stepped wedge, stratified, cluster randomized trial to evaluate the effect of primary care support on evidence-based CVD prevention and organizational change process measures. Each practice will start the trial as a control, receive the intervention at a randomized time point, and then enter a maintenance period 12 months after starting the intervention. 150 high readiness then 150 low Readiness practices will receive facilitation in a staggered manner beginning at project month 7 with the last practices starting at month 16. All practices will receive 12 months of the intense intervention including onsite QI facilitation, academic detailing, EHR support, and, through the North Carolina Health Information Exchange, a shared statewide utility providing whole population analytics, care gap identification, benchmarking, and an external reporting mechanism which otherwise would not be available to independent practices. Potential Impact: A successful intervention would prove that practice facilitation supported by effective informatics tools is an effective method of translating PCOR findings into practice. Discernible reductions in cardiovascular risk in 300 practices covering over an estimated 900,000 adult patients would likely lead to prevention of thousands of cardiovascular events within 10 years.