Primary care Implementation and evaluation of Coach McLungs™ an asthma shared decision-making intervention, across a large healthcare system

初级保健 在大型医疗保健系统中实施和评估 Coach McLungs™ 哮喘共享决策干预措施

• 批准号: 10671562
• 负责人: Hazel Tapp
• 金额: $ 71.81万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10671562
• 关键词: Adoption; Advisory Committees; Advocacy; Affect; Age; Asthma; Back; Caring; Cessation of life; Child; Chronic Disease; Clinical; Communication; Complex; Computerized Medical Record; Consolidated Framework for Implementation Research; Decision Making; Disparity; Education; Emergency department visit; Ethnic Origin; Evaluation; Family; Feedback; Funding; Gender; Goals; Health; Health Personnel; Health Policy; Health behavior change; Health system; Healthcare; Healthcare Systems; Heart Atrium; Hospitalization; Individual; Integrated Health Care Systems; Intervention; Knowledge; Measures; Medical; Methods; Morbidity - disease rate; Oral; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Persons; Primary Care; Process; Provider; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Design; Research Institute; Research Personnel; Risk; Socioeconomic Status; Steroids; System; Testing; Training; United States; Visit; Work; acute care; aged; asthmatic patient; clinical decision support; evidence base; implementation evaluation; implementation facilitators; implementation science; implementation strategy; improved; improved outcome; inflammatory lung disease; meetings; mortality; multidisciplinary; operation; patient oriented; pediatric patients; practice-based research network; primary care practice; process improvement; randomized, controlled study; shared decision making; tool; uptake; virtual

Project Summary / Abstract (30 lines) Changing behavior of health providers can be challenging, and significant gaps exist in our knowledge of how to best implement new medical evidence into everyday practice. Numerous individual- and system-level factors contribute to poor asthma outcomes which persist due to the lack of a comprehensive approach for asthma care that is scalable, sustainable, and widely disseminated. Improved asthma outcomes are associated with effective communication strategies between the patient and provider. Shared decision making (SDM) is a patient-centered process in which patients and providers work together to make decisions and select tests, treatments, and care plans based on evidence that balances risks with patient preferences and values. Previous studies, including our PCORI-funded dissemination study, have shown that SDM is associated with improved outcomes for asthma patients in primary care. Here we will evaluate the implementation of Coach McLungsSM, a virtual evidence-based asthma SDM intervention with built-in asthma education and clinical decision support, into primary care practices across a large healthcare system. Atrium Health, the 2nd largest virtually integrated healthcare system in the nation, with over 14 million patient visits per year and the region's largest primary care network, provides an ideal venue to evaluate implementation into primary care. Coach McLungsSM will be fully integrated into the electronic medical record at all primary care practices. All asthma patients aged 5-17 who attend these practices will be assessed for uncontrolled asthma. The goal of this study will be to evaluate the implementation of the Coach McLungsSM SDM intervention into primary care. Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using the RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance) framework. Research questions are: How best can we implement the Coach McLungsSM SDM asthma intervention into primary care? Will use of Coach McLungsSM in primary care improve outcomes for patients with uncontrolled asthma? After convening a Stakeholder Advisory Committee (SAC) composed of providers, researchers, patients, stakeholders with expertise in implementation science, asthma research and advocacy, we will implement the Coach McLungsSM SDM intervention into primary care practices using a stepped wedge randomized control study design. Providers and staff will be trained in SDM communication and use of the Coach McLungsSM tool. We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. The SAC will use an iterative process improvement method and give best practice recommendations back to the practices for implementation improvement. We will disseminate findings through local stakeholders, practice-based research networks, asthma advocacy national organizations, and academic research meetings for healthcare, primary care, and asthma.

项目概要/摘要（30行） 改变卫生服务提供者的行为可能具有挑战性，我们对如何改变行为的认识存在重大差距。 将新的医学证据最好地应用到日常实践中。许多个人和系统层面的因素 由于缺乏治疗哮喘的综合方法，导致哮喘结局不佳 可扩展、可持续和广泛传播的护理。改善哮喘预后与以下因素相关： 病人和医生之间的有效沟通。共享决策（SDM）是一种 以患者为中心的过程，患者和提供者共同做出决定和选择测试， 治疗和护理计划的基础上的证据，平衡风险与病人的喜好和价值。 以前的研究，包括我们的PCORI资助的传播研究，已经表明SDM与 改善哮喘患者在初级保健中的结果。在这里，我们将评估Coach的实施情况 McLungsSM，一种基于证据的虚拟哮喘SDM干预，内置哮喘教育和临床 决策支持，到整个大型医疗保健系统的初级保健实践。Atrium Health，全球第二大 全国几乎一体化的医疗保健系统，每年有超过1400万人次的患者就诊， 最大的初级保健网络，提供了一个理想的场所，以评估执行到初级保健。教练 McLungsSM将完全集成到所有初级保健诊所的电子病历中。所有哮喘 参加这些活动的5-17岁的患者将被评估为不受控制的哮喘。本研究的目的 将评估Coach McLungsSM SDM干预在初级保健中的实施情况。 将使用实施变革的专家建议（ERIC）指导实施工作， 实施战略的汇编，并使用RE-AIM（达到有效性，采用， 执行、维护）框架。研究问题是：我们如何最好地实施教练 McLungsSM SDM哮喘干预纳入初级保健？在初级保健中使用Coach McLungsSM是否会改善 哮喘控制不佳患者的治疗效果如何？在召开利益攸关方咨询委员会会议之后， 由提供者、研究人员、患者、具有实施科学、哮喘专业知识的利益相关者组成 研究和宣传，我们将实施教练McLungsSM SDM干预到初级保健实践 采用阶梯楔形随机对照研究设计。提供者和工作人员将接受SDM培训 沟通和使用教练McLungsSM工具。我们将衡量急诊室的变化 访视、住院和口服类固醇的使用，作为以患者为中心的哮喘的替代指标 结果。SAC将使用迭代过程改进方法，并提供最佳实践 将建议反馈到实践中，以改进执行情况。我们将通过以下途径传播调查结果： 当地利益相关者、基于实践的研究网络、哮喘倡导国家组织和学术界 医疗保健、初级保健和哮喘的研究会议。