SUPPORT-AF IV

项目总结/摘要 600万美国人患有心房颤动（AF），这是一种心律异常， 患病率，也是中风的主要危险因素。AF占缺血性卒中的15%，导致 60%的病例终身残疾，20%的病例死亡。口服抗凝剂（AC）对AF有效- 大多数AF患者有口服AC的指南指导适应症。 尽管如此，只有一半符合条件的AF患者接受治疗。这在非白色AF中尤其如此 患者，其中AC使用较低，中风率较高。拟议的项目，CANORT-AF IV： 通过提供者对AF口服抗凝治疗的宣传来支持AC的使用，将检查 电子健康记录（EHR）中新型AC临床决策支持工具对AC处方的影响 来自两个不同卫生系统的医疗保健提供者之间的行为。我们还将研究 通过提供者访谈和使用电子健康的行为的详细研究， 记录访问日志。最后，我们将细化警报，制定全面的传播计划， 一个实施工具包，以扩大警报在全国其他学习卫生系统的使用。具体 目的包括：目的1：（警报增强）增强警报，当符合条件的患者（AF患者） 和不使用AC的中风风险升高）访问心脏病提供者和PCP;增强功能包括链接到 教育材料、同行资源和沟通工具，用于非AC患者。目标二： （依从性：AC启动和持续）测量依从性，包括AC启动和AC持续 （持续AC治疗一年）的合格患者（n=2632），随机接受与未接受治疗的供应商 警戒;在少数患者亚组中重复测量（n= 402）。目标3：（作用机制） 测量数字碎屑与AC启动和持续性的关联;碎屑包括警报特定操作 （打开智能集并链接到患者教育材料、同行资源和通信 工具）、提醒特定订单、其他订单以及审查访问日志操作（审查各种项目-专家 笔记、心脏测试结果或药物列表）。目标4：（提供者和患者满意度）访谈 干预提供者（n=20）对警报和AC管理的满意度;访谈患者（n=25） 干预提供者对AC管理的满意度。目标5：（传播和 实施）完善警报，制定全面的传播计划，并创建实施 一个工具包，收集了从衡量有效性、效果机制和提供者中吸取的所有经验教训， 患者满意度。 我们正在申请R 01（PA-18-722）-提高患者对治疗和预防的依从性 制度。我们的研究团队汇集了AC护理，信息学，实施 科学和健康方面的差距，这将指导我们实现拟议的目标。

Project Summary/Abstract Six million Americans suffer from atrial fibrillation (AF), a heart rhythm abnormality that is increasing in prevalence and is also a major risk factor for stroke. AF accounts for 15% of ischemic strokes, resulting in permanent disability in 60% of cases and death in up to 20%. Oral anticoagulation (AC) is effective for AF- related stroke prevention and the vast majority of AF patients have a guideline-directed indication for oral AC. Despite this, only half of eligible AF patients receive treatment. This is particularly true among non-white AF patients, in whom AC use is lower and stroke rates are higher. The proposed project, SUPPORT-AF IV: Supporting Use of AC through Provider Prompting about Oral Anticoagulation Therapy for AF, will examine the impact of a novel AC clinical decision support tool within the electronic health record (EHR) on AC prescribing behaviors among healthcare providers from two distinct health systems who receive it. We will also examine clinician engagement through provider interviews and detailed study of behaviors using electronic health record access logs. Finally, we will refine the alert, develop a comprehensive dissemination plan, and create an implementation toolkit to widen the use of the alert at other learning health systems nationally. Specific Aims include: Aim 1: (alert enhancement) Enhance alert which will fire when eligible patients (those with AF and elevated stroke risk not on AC) visit cardiology providers and PCPs; enhancements include links to educational material, peership resources, and communication tools to use with patients not on AC. Aim 2: (adherence: AC initiation and persistence) Measure adherence including AC initiation and AC persistence (staying on AC for one year) in eligible patients (n=2632) of providers randomized to receive vs. not receive alert ; repeat measurements in the subset of minority patients (n= 402). Aim 3: (mechanism of effect) Measure association of digital crumbs with AC initiation and persistence; crumbs include alert specific actions (opening smart set and linking out to patient educational materials, peership resources, and communication tools), alert specific orders, other orders, and review of access log actions (review of various items - specialist notes, cardiac testing results, or medication list). Aim 4: (provider and patient satisfaction) Interview intervention providers (n=20) about satisfaction with alert and AC management; interview patients (n=25) satisfaction with AC management received from intervention providers. Aim 5: (dissemination and implementation) Refine alert, develop a comprehensive dissemination plan, and create an implementation toolkit that captures all lessons learned from measuring effectiveness, mechanism of effect, and provider and patient satisfaction. We are applying for the R01 (PA-18-722) - Improving Patient Adherence to Treatment and Prevention Regimens. Our research team brings together extensive expertise in AC care, informatics, implementation science and health disparities that will guide us in the execution of the proposed aims.