Disseminating and Implementing PCOR through the Oklahoma Primary Healthcare Extension System

 描述（由申请人提供）：一个县为基础的俄克拉荷马州初级保健推广系统的发展正在顺利进行。我们现在建议增加一个基层医疗保健改进中心，以支持基层医疗实践的持续质量改进，包括电子绩效反馈，学术细节，实践便利，信息技术支持和最佳实践的共享。能力建设步骤将包括发展生成质量改进电子报告的能力，并跟踪健康成果的改善情况，以及建立一个导航和协作功能，将实践和社区与研究界联系起来。该项目将完成三项重要任务：1）建立一个有效和可持续的初级卫生保健改善中心，以传播和实施以患者为中心的成果研究成果; 2）帮助300个中小型初级卫生保健实践改善对四种心血管疾病危险因素的管理，吸烟，血压，胆固醇和低剂量阿司匹林的使用;（三）认真评估实施策略的成效。 心血管风险降低项目将采用阶梯楔形设计，按县随机分组，按地理象限分层，分为4波，每波75次，每波在前一波后3个月开始。第二次随机分配将首先进行戒烟和血压控制或血脂管理和低剂量阿司匹林，6个月后切换到其他两个。执行战略将持续一年。在基线时和所有实践中每隔3个月，将从实践使用的健康信息交换中以电子方式获得实践性能和患者结局数据，持续18个月。将在基线、1年和18个月时测量实践和干预特征，并评估其对实践绩效改善和患者结局的影响。我们还将衡量实施策略对Solberg变革模型（优先级，变革能力和护理过程内容）组成部分的影响，以及实践的适应性储备。 在项目的第三年，我们将帮助实践实施护理协调、基于HIE的临床医生和患者决策支持以及登记管理等流程，这些流程是采用许多未来PCOR结果所需的流程。

 DESCRIPTION (provided by applicant): Development of a county-based Oklahoma Primary Healthcare Extension System is well underway. We are now proposing to add a Primary Healthcare Improvement Center to support continuous quality improvement in primary care practices with electronic performance feedback, academic detailing, practice facilitation, information technology support, and sharing of best practices. Capacity-building steps will include development of the ability to generate electronic reports for quality improvement and to track improvements in health outcomes and creation of a Navigation and Collaboration Function that connects practices and communities to the research community. The project will accomplish three important tasks: 1) construct an effective and sustainable Primary Healthcare Improvement Center to disseminate and implement the results of patient-centered outcomes research; 2) help 300 small to medium-sized primary care practices improve management of four cardiovascular disease risk factors, smoking, blood pressure, cholesterol, and use of low- dose aspirin; and 3) carefully evaluate the effectiveness of the implementation strategies. The cardiovascular risk reduction project will use a stepped wedge design with randomization of practices by county, stratified by geographic quadrant, to 4 waves of 75 practices, each wave beginning 3-months after the previous wave. A second randomization will assign practices to work first on either smoking cessation and blood pressure control or lipid management and low-dose aspirin switching to the other two after 6 months. The implementation strategies will be continued for a total of one year. Practice performance and patient outcome data will be obtained electronically from the health information exchanges used by the practices at baseline and at 3 month intervals in all practices for 18 months. Practice and intervention characteristics will be measured at baseline, at one year, and at 18 months and their effects on practice performance improvements and patient outcomes will be assessed. We will also measure the impact of the implementation strategies on the components of Solberg's Change Model (priority, change capacity, and care process content) as well as the practice's adaptive reserve. During the third year of the project we will help practices implement processes such as care coordination, HIE-based clinician and patient decision-support, and registry management, processes required for adoption of many future PCOR findings.