Disseminating and Implementing PCOR through the Oklahoma Primary Healthcare Extension System

 描述(由申请者提供)：俄克拉荷马州初级卫生保健扩展系统的开发工作进展顺利。我们现在提议增加一个初级医疗保健改进中心，以支持初级保健实践的持续质量改进，包括电子绩效反馈、学术详细说明、实践便利化、信息技术支持和最佳实践共享。能力建设步骤将包括发展生成提高质量的电子报告和跟踪健康成果的改善情况的能力，以及建立一个将做法和社区与研究界联系起来的导航和协作功能。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医疗保健改进中心，以传播和实施以患者为中心的结果研究结果；2)帮助300家中小型初级保健诊所改善对吸烟、血压、胆固醇和使用低剂量阿司匹林四种心血管疾病风险因素的管理；以及3)认真评估实施战略的有效性。心血管风险降低项目将使用阶梯楔形设计，按县随机实践，按地理象限分层，至4波75次实践，每波从前一波后3个月开始。第二个随机化将首先分配戒烟和血压控制或血脂管理和小剂量阿司匹林的实践，6个月后改为另两个。执行战略将持续一年。业务绩效和患者结果数据将以电子方式从业务所使用的健康信息交换中获得，所有业务在18个月内每隔3个月在基线上进行一次交换。将在基线、一年和18个月时衡量实践和干预特征，并评估它们对实践绩效改进和患者结果的影响。我们还将衡量实施战略对索尔伯格变化模型的组成部分(优先级、变化能力和护理过程内容)以及实践的适应性储备的影响。在项目的第三年，我们将帮助实践者实施护理协调、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的PCOR结果所需的。

 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.