Measure development to accelerate the translation of evidence based clinical guidelines into practice

摘要。一半的美国成年人有一个或多个可预防的心血管危险因素。 包括高血压（HTN）和高脂血症在内的心血管疾病（CVD），但只有10%的人符合其所有临床 由于采用指南推荐的护理不理想而导致的目标。这主要是因为初级保健 实践和卫生保健系统正在努力确定护理结构和 他们需要实施的流程，以成为高性能的实践。本提案的目的是 通过开发一种可靠、有效和务实的评估工具来解决这一翻译差距， 初级保健实践的核心特征与CVD相关结局的高性能相关。尽管 大量的实践转化和改进研究，缺乏系统性和可扩展性， 确定初级保健基础设施和流程的哪些特征与更好的 患者结局。缺乏可靠、有效、实用的评估工具来定义实践变化 推动初级保健高绩效的因素继续阻碍着循证保健的实施， 慢性病预防和将医疗保健创新转化为日常实践。因此我们 提出一个混合方法的研究结合数据分析，调查技术的背景下，两个阶段 德尔菲法和定性深入访谈，以界定和优先考虑护理结构的要素， 过程（例如，决策支持），假设与CVD相关的改善相关 患者结局。然后，我们将开发和验证一个测量工具，用于确定护理结构中的差距 和过程，是经得起变化的，如果实施，将改善心血管疾病相关的患者的结果。 该提案的优势在于四个临床和转化科学研究所之间的合作：（1）新 约克大学医学院（NYUSoM）-健康与医院CTSI（NYU-H+H CTSI），（2）俄勒冈州 健康与科学大学（OHSU）俄勒冈州临床转化研究所（OCTRI），（3）医学 南卡罗来纳州大学的南卡罗来纳州临床转化研究所（SCTR），以及（4） 临床和转化研究在爱因斯坦和蒙蒂菲奥里（卢旺达问题国际法庭），和六个地理上不同的 与国家实践网络建立伙伴关系，这些网络将组成本提案的研究小组。拟议研究 意义重大，因为它将填补阻碍医疗保健创新转化为 例行训练因此，使用评估工具的结果将为以下方面提供急需的路线图： 建设能力和基础设施，促进实践转变，持续质量改进（即，通过 和创新的可持续性）和改善人口健康。

ABSTRACT. Half of the U.S. adult population has one or more preventable risk factors for cardiovascular disease (CVD) including hypertension (HTN) and hyperlipidemia, but only 10% are meeting all of their clinical goals due to suboptimal adoption of guideline recommended care. This is largely because primary care practices and health care systems are struggling to identify which combination of care structures and processes they need to implement to become high performing practices. The objective of this proposal is address this translational gap by developing a reliable, valid, and pragmatic assessment tool that will identify core features of primary care practices that are related to high performance on CVD-related outcomes. Despite a large body of research on practice transformation and improvement, we lack a systematic and scalable approach to identifying which features of primary care infrastructure and processes are associated with better patient outcomes. This lack of a reliable, validated, pragmatic assessment tool to define the practice changes that drive high performance in primary care continues to impede implementation of evidence-based care for chronic disease prevention and the translation of innovations in health care into routine practice. We therefore propose a mixed-methods study combining data analytics, survey techniques in the context of a two-stage Delphi process and qualitative in-depth interviews to delineate and prioritize elements of care structure and processes (e.g., decision support) that are hypothesized to be associated with improvements in CVD-related patient outcomes. We will then develop and validate a measurement tool for identifying gaps in care structures and processes that are amenable to change, and if implemented, will improve CVD-related patient outcomes. A strength of this proposal is collaboration across four Clinical and Translational Science Institutes: (1) New York University School of Medicine (NYUSoM)-Health and Hospitals CTSI (NYU-H+H CTSI), (2) Oregon Health & Science University (OHSU) Oregon Clinical Translational Research Institute (OCTRI), (3) Medical University of South Carolina's South Carolina Clinical Translational Institute (SCTR), and (4) the Institute for Clinical and Translational Research at Einstein and Montefiore (ICTR), and six geographically diverse partnering national practice networks that will form the research team for this proposal. The proposed research is significant because it will fill a methodological gap that impedes translation of innovations in health care into routine practice. Findings from use of the assessment tool will therefore provide a much-needed roadmap for building capacity and infrastructure for practice transformation, continuous quality improvement (i.e., adoption and sustainability of innovation) and improvements in population health.