Tailored Communication to Reduce Cardiovascular Risk

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DESCRIPTION (Provided by the Applicant): Stephen D. Persell, MD, MPH is an academic general internist, health services researcher, and practicing primary care physician. He is applying for the K08 Mentored Clinical Scientist Development Award to advance his long-term goal of developing an independent research program to design and test preventive cardiology quality improvement interventions integrated into primary care settings using tailored patient communication and information technology. This goal will be achieved through a 5-year career development program that includes didactic training and mentored research. The major objectives of this program are: 1) to acquire advanced theoretical and practical skills in health communications; 2) to gain skills and experience in the research methods used to design and evaluate information technology-based interventions performed in real-life health care settings; and 3) to develop and test an intervention designed to improve the appropriate use of aspirin and cholesterol lowering therapy in patients at high risk for cardiovascular events. This intervention will involve using a population-based information technology approach coupled with the development of individually tailored messages sent directly to patients. The objectives of the award will be advanced through the four phases of the research plan. Phase 1 consists of an analysis of the accuracy and sources of error occurring when data from a contemporary electronic medical record are used to classify patients' cardiovascular risk and identify unaddressed risk factors. Phase 2 includes a qualitative and quantitative study to elicit physician attitudes, barriers and possible solutions to the implementation of an office system to improve preventive cardiology using direct communication with patients. Phase 3 consists of a study of patients' responses to model messages. Phase 4 is a trial testing the feasibility and efficacy of a messaging intervention to improve patients' appropriate use of aspirin and cholesterol lowering therapy. The results of this research plan should justify a larger trial of this intervention and serve as a prototype for the development of other direct-to-patient interventions. The award will provide Dr. Persell with a crucial experience performing a health-care system intervention and facilitate his development of advanced skills.