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

 描述(申请人提供)：背景：北卡罗来纳州心血管疾病的负担仍然很大。现有的最新数据显示，该州每年的心血管死亡率为每10万人中有263人死亡，这解释了该州近三分之一的死亡人数。疾病的进展在很大程度上是由几个风险因素决定的，包括高血压或胆固醇升高，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这些患者中的一半以上实现降低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能加速PCOR结果的传播和实施，以改善心脏健康，并提高初级保健实践的能力，以便在未来纳入其他PCOR结果。方法：FAST PACE NC是一项阶梯式、分层、整群随机试验，旨在评估初级保健支持对循证心血管疾病预防和组织变革过程措施的影响。每种做法都将作为对照开始试验，在随机的时间点接受干预，然后在开始干预后12个月进入维持期。150个高就绪性和150个低就绪性实践将从项目第7个月开始以交错的方式得到促进，最后一个实践从第16个月开始。所有实践将得到为期12个月的密集干预，包括现场QI促进、学术细节、EHR支持，以及通过北卡罗来纳州健康信息交换，提供全州范围内的共享公用事业，提供人口分析、护理差距识别、基准和外部报告机制，否则独立实践将无法获得这些干预。潜在影响：成功的干预将证明有效的信息学支持的实践促进 工具是将变革和组织振兴方案的调查结果付诸实践的有效方法。在覆盖超过90万名成年患者的300项实践中，心血管风险的明显降低可能会在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.