Southwest Health Extension Partnership to Enhance Research Dissemination (SHEPERD)

 简介(申请人提供)：美国每年报告的死亡病例中，有三分之一是由心血管疾病(CVD)引起的。从以患者为中心的结局研究(PCOR)得出的应对心血管疾病危险因素的策略可以极大地减轻心血管疾病的负担。初级保健做法必须转变，以提供更高水平的PCOR循证预防，以降低心血管风险。强调以患者为中心的护理的PCOR干预措施，包括自我管理支持、基于团队的护理、改进的信息系统和积极的质量改进，已被证明是有效的。实践通常需要将新计划整合到临床操作中的帮助。实践便利化已被证明加强了初级保健中慢性病患者新方案的实施。其他实践支持方法，包括学术详细介绍、协作学习会议和卫生信息技术援助，本身以及与实践便利化相结合，也被证明是有效的。患者的参与也可能有助于实践的转变。越来越多的实践通过创建患者咨询委员会并将患者纳入实践质量改进团队，积极地将患者作为变革过程的一部分。患者参与的另一种为循证护理实施提供信息的方法是Boot Camp转换流程，在该流程中，患者与初级保健临床医生、工作人员和社区成员合作，将最佳实践转化为当地层面上与文化和社区相关的实施。然而，尽管这些努力取得了相当大的成功，但还没有研究将患者参与策略添加到上面列出的实践转型的更标准方法中的增量价值。该项目将实施西南卫生推广计划以加强研究传播(Sheperd)，作为一个合作计划，以建设初级保健实践能力，以提高科罗拉多州和新墨西哥州中小型初级保健实践的质量、变革管理和实施PCOR结果，最初重点是心血管护理。它还将与外部匹配的队列对照组进行整群随机试验，以检查实施PCOR干预措施以降低初级保健实践中心血管风险的两种做法转变的覆盖范围、有效性、采用、实施和维护，比较1)标准做法转变支持干预措施(包括执业便利、做法评估和反馈、HIT援助、学术详细说明和协作学习会议)和2)将患者参与活动(包括患者咨询委员会和新兵训练营翻译)作为做法转变支持的一部分的影响。该项目将提供有关患者参与实践转型工作的附加值的重要信息，还将在整个区域形成一个实践网络，增强实践转型和执行变革和改革方案结果的能力。

 DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) causes one in three deaths reported each year in the United States. Strategies derived from patient-centered outcomes research (PCOR) that address CVD risk factors can greatly reduce the burden of CVD. Primary care practices must transform to deliver a higher level of PCOR evidence- based prevention to decrease cardiovascular risk. PCOR interventions that emphasize patient-centered care including self-management support, team-based care, improved information systems, and active quality improvement have been shown to be effective. Practices often require assistance integrating new programs into clinical operations. Practice facilitation has been shown to enhance implementation of new programs for patients with chronic disease in primary care. Other methods of practice support, including academic detailing, collaborative learning sessions, and health information technology assistance, have also been shown to be effective, by themselves and in combination with practice facilitation. Patient involvement may also aid practice transformation. Increasingly, practices are actively including patients as part o the change process through the creation of patient advisory councils and including patients in practice quality improvement teams. Another method of patient involvement to inform implementation of evidence-based care is the Boot Camp Translation process, in which patients collaborate with primary care clinicians, staff members, and community members to translate best practices into culturally and community relevant implementation at the local level. However, while these efforts have had considerable success, no study has looked at the incremental value of adding patient engagement strategies to the more standard approaches to practice transformation listed above. This project would implement the Southwest Health Extension Program to Enhance Research Dissemination (SHEPERD) as a cooperative program to build primary care practice capacity for quality improvement, change management, and implementation of PCOR findings in small and medium size primary care practices in Colorado and New Mexico, with an initial focus on cardiovascular care. It also would conduct a cluster randomized trial with an external matched cohort control group to examine the Reach, Effectiveness, Adoption, Implementation, and Maintenance of two approaches to practice transformation to implement PCOR interventions for reducing cardiovascular risks in primary care practices, comparing the impact of 1) a standard practice transformation support intervention (including practice facilitation, practice assessment with feedback, HIT assistance, academic detailing, and collaborative learning sessions) to 2) an approach that adds patient engagement activities (including patient advisory councils and boot camp translation) as part of the practice transformation support. This project will provide critical information regarding the added value of patient engagement in practice transformation efforts and will also result in a network of practices across the region with increased capacity for practice transformation and implementation of PCOR findings.