Healthy Hearts for Michigan (HH4M): Providing support to improve the heart health and help reduce CVD disparities by engagement with primary care practices.

项目摘要。心脏病发作和中风是美国的两大死因， 造成约80万人死亡，医疗保健和残疾成本均超过3000亿美元 年。为了减轻这一负担，2011年，美国卫生与公众服务部启动了百万 心脏运动通过推广临床的ABC来预防100万心脏病发作和中风 预防(阿司匹林治疗、血压控制、胆固醇管理和戒烟)。 密歇根州是美国心血管疾病(CVD)负担最高的10个州之一。这个 CDC估计，密歇根州每10万人中有1,379人患心血管疾病。大约35%的心肌梗塞成人有 高血压(HTN)，77%的人服用高血压药物，20%的人报告他们吸烟。 农村人群的HTN患病率高于平均水平，而且更有可能是身体上的 与城市县相比，不活跃、吸烟和患有糖尿病。密歇根州近25%的人口 居住在农村社区，在那里个人经常面临到他们的初级保健提供者的较长开车时间，并且 供应商短缺。在密歇根州的57个非大都市县中，每个县都缺乏个人电脑业务。 AHRQ资助的EvidenceNoW计划内的工作表明，一些基于证据的QI策略可以 改善心血管疾病护理可以在资源有限的小型PC实践中进行调整和实施。健康的人 密歇根之心(HH4M)项目将在EvidenceNow的基础上，通过建立全州合作和 MI的实践协调员网络，他们将支持小型农村实践，以实施临床干预措施 改进HTN和戒烟方法，并提供有关ABC证据的教育。这些努力将结合在一起 通过远程医疗优化健康IT以及远程监控和管理，以解决以下障碍 马里兰州农村地区的准入和医疗保健短缺。我们召集了一次多学科合作，包括 Altarum研究所，密歇根农村卫生中心，上半岛医疗解决方案，美国 医学协会，密歇根州卫生与公众服务部，西北大学和 医生顾问。我们的协作建立在Altarum和我们基于MI的合作伙伴之前的工作基础上，提供 对小型初级实践的质量改进支持，并从成功的证据中吸取教训现在 推广循证最佳做法并在#年建立可持续的初级保健推广服务的计划 密歇根州。 HH4M的具体目标是：(1)召集和评估全州合作社的发展，以 支持HTN患者和吸烟者在门诊实施HH4M模式； 以及(2)评估农村实践实施HH4M模式要素的能力，方法是确定 可持续实施的促进者和障碍，并测试该模型是否可以改善(A)血压 在一名飞行员和三波试验的阶梯楔形试验中进行烟草使用筛查和戒烟。

Project Abstract. Heart attack and stroke are two of the leading causes of death in the United States, accounting for approximately 800,000 deaths, and over $300 billion in healthcare and disability costs each year. To reduce this burden, in 2011, the U.S. Department of Health and Human Services launched the Million Hearts campaign to prevent one million heart attacks and strokes by promoting the "ABCS" of clinical prevention (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation). Michigan is among the top 10 states with the highest cardiovascular disease (CVD) burden in the US. The CDC estimates a CVD rate of 1,379 per 100K people in Michigan (MI). Approximately 35% of MI adults have hypertension (HTN), with 77% taking high blood pressure medication, and 20% reporting they were smoking. Rural populations experience a higher than average prevalence of HTN and are more likely to be physically inactive, use tobacco, and have diabetes, when compared with urban counties. Almost 25% of MI's population live in rural communities where individuals often face extended drive times to their primary care provider and provider shortages. Each of Michigan's 57 nonmetropolitan counties have a shortage of PC practices. Work within the AHRQ-funded EvidenceNOW program suggests that some evidence-based QI strategies to improve CVD care can be adapted and implemented in small PC practices with limited resources. The Healthy Hearts for Michigan (HH4M) project will build on EvidenceNOW by establishing a statewide cooperative and network of practice facilitators in MI who will support small rural practices to implement clinical interventions to improve HTN and tobacco cessation and provide education on ABCS evidence. These efforts will be coupled with optimization of health IT and remote monitoring and management through telehealth to address barriers to access and healthcare shortages in rural MI. We have convened a multi-disciplinary collaborative that includes Altarum Institute, Michigan Center for Rural Health, Upper Peninsula Healthcare Solutions, the American Medical Association, Michigan Department of Health and Human Services, Northwestern University and physician advisors. Our collaborative builds on the prior work of Altarum and our MI-based partners, delivering quality improvement support to small primary practices, with the learnings from a successful EvidenceNOW program to spread evidenced-based best practices and build a sustainable primary care extension service in Michigan. Specific Aims of HH4M are to: (1) convene and evaluate the development of a statewide cooperative to support the in-clinic implementation of the HH4M model for patients with HTN and patients who use tobacco; and (2) evaluate the ability of rural practices to implement the elements of the HH4M model by identifying facilitators and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation in a stepped-wedge trial with a pilot and three waves.