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

心脏病是美国人死亡的主要原因， 每年3200亿美元的医疗费用和生产力损失。制造业社区， 其中许多是农村地区，吸烟、肥胖、缺乏体育活动的比例明显较高， 糖尿病和心血管疾病的死亡率。同样，制造业 就业与高血压和吸烟率较高有关。三分之二的 制造业工人是男性，制造业工人的平均年龄超过 其他行业的工人。 许多大型制造商为员工、配偶、家属和 通过工作场所保健诊所，特别是在缺乏保健服务的地区， 初级保健提供者。考虑到他们进入制造业社区的潜力， 保健诊所完全有能力解决小型和农村社区的不足之处。 在这项研究中，健康的心脏在制造业（HHM），我们建议检查使用 工作场所健康诊所作为改善制造业心血管护理的工具 社区.我们将调整一套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 促进、卫生信息技术支持以及数据反馈和基准。在 在获得AHRQ的赠款之前，我们的团队已经成功地实施了这些心血管 对小型初级保健医生的做法进行干预。 具体目标是：（1）根据工作场所诊所的实际情况， 心血管疾病护理的干预措施，以前设计用于在小 初级保健实践;（2）在12个随机选择的工地诊所实施HHM， 促进者和障碍，以可持续的维护HHM，并测试是否HHM改善 高血压控制和烟草筛查及戒烟干预;以及（3）估计 HHM的预算影响以及对公司和医疗保险的潜在医疗保健节省。 这项研究是创新的，它使用工作场所的健康诊所作为一种手段，以改善护理， 难以接触到的农村人口，他们吸烟和慢性病的比例很高。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 揭示了一个经济上可持续的质量改进战略，以解决心脏健康， 高危人群。这项研究将产生调查结果、工具、材料和教训， 在工作场所卫生诊所开展以证据为基础的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.