SUPPORT-AF IV

项目摘要/摘要 600万美国人患有心房颤动(AF)，这是一种心律异常，在 中风患病率高，也是中风的主要危险因素。房颤占缺血性中风的15%，导致 60%的病例为永久性残疾，高达20%的病例死亡。口服抗凝(AC)治疗房颤有效 与卒中预防相关，绝大多数房颤患者都有口服AC的指南指导的适应症。 尽管如此，只有一半符合条件的房颤患者得到了治疗。在非白人房颤中尤其如此 患者中，AC使用率较低，中风发生率较高。拟议的项目Support-AF IV： 通过提供有关口服抗凝治疗房颤的提示来支持AC的使用，将检查 电子健康记录中新型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卫生保健提供者之间的行为。我们还将检查 临床医生通过访问提供者和对使用电子健康的行为进行详细研究而参与进来 记录访问日志。最后，我们将细化警报，制定全面的传播计划，并创建 一个实施工具包，以扩大警报在全国其他学习卫生系统中的使用。特定的 目标包括：目标1：(增强警报)增强警报，在符合条件的患者(房颤患者)时发出警报 和增加的中风风险不在AC上)访问心脏病提供者和PCP；增强包括链接到 与非AC患者一起使用的教育材料、同行资源和交流工具。目标2： (坚持：AC发起和持续)衡量坚持，包括AC发起和AC持续 (在AC上停留一年)随机接受与不接受提供者的符合条件的患者(n=2632) 警示；在少数族裔患者亚组(n=402)中重复测量。目标3：(作用机制) 测量数字碎屑与AC启动和持久性的关联；碎屑包括警报特定操作 (打开Smart Set并链接到患者教育材料、同行资源和交流 工具)、提醒特定订单、其他订单以及查看访问日志操作(查看各种项目-专家 备注、心脏测试结果或药物清单)。目标4：(提供者和患者满意度)面谈 干预提供者(n=20)对警报和AC管理的满意度；采访患者(n=25) 干预提供者对空调管理的满意度。目标5：(传播和 实施)完善警报，制定全面的传播计划，并制定实施 工具包，捕捉从测量有效性、效果机制和提供者中学到的所有经验 病人满意度。 我们正在申请R01(PA-18-722)-提高患者对治疗和预防的依从性 养生法。我们的研究团队汇集了AC护理、信息学、实施方面的广泛专业知识 科学和健康差距将指导我们执行拟议的目标。

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.