Healthy Hearts in Manufacturing: Improving Cardiovascular Care in Worksite Health Clinics

心脏病是美国的头号死因，导致的死亡人数超过 每年3200亿美元的医疗成本和生产力损失。制造业社区， 其中许多是农村地区，吸烟率、肥胖率、缺乏体力活动的比例都要高得多， 与其他社区相比，糖尿病和心血管死亡的风险更高。同样，制造业 就业与较高的高血压和吸烟率相关。三分之二的人 制造业工人是男性，制造业工人的平均年龄比 其他行业的工人。 许多大型制造商为员工、配偶、家属和 通过工作场所卫生诊所退休人员，特别是在缺乏人力资源的地区 初级保健提供者。鉴于他们进军制造业社区的潜力，工作现场 卫生诊所在解决小型和农村社区的缺陷方面处于有利地位。 在这项名为制造健康心脏(HHM)的研究中，我们建议检查使用 作为改善制造业心血管护理的载体的工作场所健康诊所 社区。我们将采用一系列与高血压相关的循证干预措施 和戒烟，在循证支持下实施，包括现场实践 便利化、卫生信息技术支持、数据反馈和标杆。在……里面 在AHRQ的资助之前，我们的团队已经成功地实施了这些心血管疾病 小规模初级保健医生执业的干预。 具体目标是：(1)适应工作场所诊所的背景，以证据为基础 心血管疾病护理干预措施，以前设计为在小规模实施 初级保健实践；(2)在随机选择的12个工作地点诊所实施HHM，确定 HHM可持续维护的促进者和障碍，并测试HHM是否改进 高血压控制、烟草筛查和戒烟干预；以及(3)估计 HHM的预算影响以及对公司和联邦医疗保险的潜在医疗节省。 这项研究在使用工作场所卫生诊所作为改善护理的手段方面具有创新性 难以接触到的、不成比例的农村人口，吸烟率高，慢性病发病率高。它 这也将是报告工作场所卫生诊所质量措施的第一次努力。结果可能 揭示经济上可持续的质量改进战略，以解决 高危人群。这项研究将产生发现、工具、材料和经验教训，可能有助于 在工作场所卫生诊所实施循证质量改进的其他努力。

Heart disease is the leading cause of death in the United States and contributes to more than $320 billion annually in health care costs and lost productivity. Manufacturing communities, many of which are rural, have significantly higher rates of smoking, obesity, physical inactivity, diabetes, and cardiovascular deaths, compared to other communities. Similarly, manufacturing employment is associated with higher rates of hypertension and smoking. Two-thirds of manufacturing workers are male, and manufacturing workers are, on average, older than workers in other industries. Many large manufacturers provide health services to employees, spouses, dependents, and retirees through worksite health clinics, particularly in areas where there are shortages of primary care providers. Given their potential reach into manufacturing communities, worksite health clinics are well positioned to address deficiencies in small and rural communities. In this study, Healthy Hearts in Manufacturing (HHM), we propose to examine the use of worksite health clinics as a vehicle for improving cardiovascular care in manufacturing communities. We will adapt a package of evidence-based interventions related to hypertension and tobacco cessation, implemented with evidence-based supports, including on-site practice facilitation, health information technology support, and data feedback and benchmarking. In prior grants from AHRQ, our team has successfully implemented these cardiovascular interventions in small primary care physician practices. The specific aims are to: (1) Contextually adapt, for worksite clinics, evidence-based interventions for cardiovascular disease care, previously designed for implementation in small primary care practices; (2) Implement HHM in 12 randomly selected worksite clinics, identify facilitators and barriers to sustainable maintenance of HHM, and test whether HHM improves hypertension control and tobacco screening and cessation intervention; and (3) Estimate the budget impact of HHM and the potential health care savings to companies and Medicare. This study is innovative in its use of worksite health clinics as a means to improve care for a hard-to-reach, disproportionally rural population with high rates of smoking and chronic illness. It will also be a first effort to report on quality measures from worksite health clinics. Results may reveal an economically sustainable quality improvement strategy to address heart health for an at-risk population. The study will produce findings, tools, materials, and lessons that could aid other efforts to implement evidence-based quality improvement in worksite health clinics.