The Alabama Cardiovascular Cooperative: Supporting Cardiovascular Risk Reduction in Primary Care

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In the United States (U.S.), the last three decades have seen vast improvements in cardiovascular disease (CVD) risk and mortality, however, these gains are not consistent across all regions of the country. Inequities in cardiovascular outcomes remain, and in some cases have widened, across racial, socio-economic, and geographic lines. In the Southeastern U.S., rates of stroke, myocardial infarction (MI), diabetes and obesity are among the highest in the nation. According to data from millionhearts.org, Alabama has the highest rate of CVD events (death, hospitalizations, ED visits) among all 50 states. Although evidence-based guidelines for screening and treatment of cardiovascular risk factors exist, implementation is often suboptimal. Many factors contribute to the research-to-practice gap, including educational deficiencies, time constraints for providers, lack of feedback mechanisms and decision support tools, as well as cultural factors and organizational climate. There is potential for real impact in CVD health if primary care providers and patients are provided with tools to address cardiovascular health (i.e., assess and manage cardiovascular risks), particularly in the rural south. With this application, we propose the creation of the Alabama Cardiovascular Cooperative to promote coordination of statewide efforts to improve cardiovascular risk and reduce disparities. Partners include 5 organizations with long-standing commitments to improving health outcomes in Alabama, broad statewide reach, and a shared belief that a coordinated effort to support primary care-based initiatives to improve CVD health in Alabama could prove transformative; these entities include the Alabama Department of Public Health (ADPH), the Alabama Quality Assurance Foundation (AQAF), the Alabama Primary Health Care Association (APHCA), Auburn University School of Pharmacy, and the University of Alabama at Birmingham School of Medicine (UAB). We will engage primary care practices from across the state in a sustainable, CVD-focused “community of practice.” We will implement a Heart Health Improvement project in 60 primary care clinics with suboptimal rates of blood pressure (BP) control and screening for smoking status using a 3-prongued approach comprising Practice Facilitation & Technical Assistance, Online & eLearning, and Improvement through Data Transparency. We will use a Type I hybrid design, to simultaneously test the effects of the intervention on BP and smoking-related outcomes while also gathering information on implementation. The outcomes evaluation will be guided by the Proctor’s Framework for Implementation Outcomes, and we will assess implementation using the Consolidated Framework for Implementation Research. Through these coordinated efforts, our overarching goal is to propel Alabama out of the bottom quartile for cardiovascular outcomes and reduce rural/urban and racial disparities.