Adapting Guideline Implementation to Local Environments (AGILE) in Primary Care After Telehealth Expansion

远程医疗扩展后，使初级保健中的指南实施适应当地环境 (AGILE)

• 批准号: 10604363
• 负责人: Edmond Ramly
• 金额: $ 15.97万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-08 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10604363
• 关键词: Adapting; Guideline; Implementation; Local; Environments

PROJECT SUMMARY / ABSTRACT Urgent expansion of telehealth due to the COVID-19 pandemic may have consequences for evidence based primary care, including worsening disparities in cardiovascular disease (CVD) prevention. Implementing evidence based guidelines to reverse CVD risk would prevent more than 50% of annual deaths in middle-aged US adults but is already uneven. Guideline adherence can be improved by tailoring strategies to local barriers as in Dr. Ramly’s prior work that increased follow up on blood pressure and smoking with higher gains among Black patients. Yet tailoring is too expensive and burdensome to be used in practice and is even less feasible with the rapid telehealth expansion. There is a critical need for an alternative to tailoring to enable primary care clinics to rapidly adapt how they implement CVD guidelines after telehealth expansion to avoid worsening disparities. In engineering, configurable solutions make menus of options available to avoid expensive individual tailoring. This approach could enable clinics to use known strategies to address local barriers without engaging in an expert-led individual tailoring process. Preliminary qualitative work found many barriers to optimal care with telehealth that are modifiable with known strategies. Yet configurable solutions using known strategies have not been applied in health care despite the potential to reduce cost and reduce disparities by addressing local needs. Applying this approach will require multi-stakeholder design of a configurable toolkit informed by large clinical data and tested by a pragmatic clinical trial. Dr. Ramly’s long-term goal is to become a clinical investigator in primary care leading an independent research program to improve rapid implementation of evidence based care for chronic conditions. This 5-year K01 will fill his clinical investigation training gaps with mentored research and training in large clinical data, mixed methods, and pragmatic clinical trials. As a systems engineer faculty in a clinical department, Dr. Ramly is well prepared for a successful K01 to transition from engineer collaborator to independent clinical investigator. The overall objective of this proposal is to develop and pilot a configurable toolkit for CVD prevention. Four CVD quality metrics will be targeted: blood pressure control for patients with hypertension, and aspirin, statins, and smoking cessation for patients with coronary artery disease. The specific aims are to: 1) characterize barriers to implementation of CVD guidelines in primary care after telehealth expansion, 2) develop a configurable toolkit of strategies to address local barriers, and 3) pilot test the toolkit to assess reach, effectiveness, adoption, implementation, and maintenance, including subgroup differences. Expected outcomes are an intervention addressing a critical gap in evidence based care after telehealth expansion, with preliminary data for an AHRQ R18 trial. Dr. Ramly will become an independent clinical investigator building on prior expertise in engineering and implementation science. His current and future research aims will advance AHRQ’s mission by focusing on AHRQ-relevant priority populations (chronic conditions, older adults), problem (heart health) and emphasis (primary care).

项目摘要/摘要 新冠肺炎大流行导致的远程医疗紧急扩张可能会产生基于证据的后果 初级保健，包括心血管疾病预防方面日益严重的差距。实施 逆转心血管疾病风险的循证指南将防止中年人每年50%以上的死亡 美国成年人，但已经参差不齐了。指导方针的遵从性可以通过针对当地障碍量身定做战略来提高 与Ramly博士之前的工作一样，增加了对血压和吸烟的随访，并在 黑人病人。然而，裁剪成本太高，负担太重，不能在实践中使用，而且更不可行 随着远程医疗的快速扩张。迫切需要一种替代定制的方法来实现初级保健 诊所在远程医疗扩展后迅速调整其实施心血管疾病指南的方式，以避免病情恶化 差距。在工程设计中，可配置的解决方案使选项菜单可用，以避免昂贵 个人裁剪。这种方法可以使诊所能够使用已知的策略来解决当地的障碍，而不是 参与由专家领导的个人定制过程。初步的定性工作发现了许多障碍 远程医疗的最佳护理，可通过已知策略进行修改。但可配置的解决方案使用已知 战略尚未应用于卫生保健，尽管有可能通过以下方式减少成本和缩小差距 满足当地需求。应用这种方法将需要多个利益相关者设计一个可配置的工具包 由大量临床数据提供信息，并通过务实的临床试验进行测试。拉姆利博士的长期目标是成为 初级保健领域的临床调查员领导独立研究计划，以提高快速 对慢性病实施循证护理。这5年的K01将填补他的临床研究 在大量临床数据、混合方法和实用临床方面的指导性研究和培训的培训差距 审判。作为临床系的系统工程师，Ramly博士已经为成功的K01做好了充分的准备 从工程师合作者过渡到独立的临床研究人员。这样做的总体目标是 建议是开发和试行一个可配置的心血管疾病预防工具包。四个CVD质量指标将是 目标：高血压患者的血压控制，以及阿司匹林、他汀类药物和戒烟的治疗 患有冠状动脉疾病的患者。具体目标是：1)确定实施的障碍 远程医疗扩展后初级保健中的CVD指南，2)开发可配置的战略工具包，以 解决当地障碍，以及3)对工具包进行试点测试，以评估覆盖范围、有效性、采用、实施、 和维持性，包括亚群差异。预期结果是一种干预，旨在解决关键的 远程医疗扩展后循证护理的差距，AHRQ R18试验的初步数据。拉姆利博士 将成为一名独立的临床研究员，建立在工程和实施方面的先前专业知识基础上 科学。他目前和未来的研究目标将通过专注于与AHRQ相关的研究来推进AHRQ的使命 优先人群(慢性病、老年人)、问题(心脏健康)和重点(初级保健)。