Implementing Shared Decision Making (SDM) for Individualized CV Prevention (SDM4IP)

项目摘要/摘要 心血管(CV)事件的一级预防通常在以下个人中更强烈 风险较低，反之亦然(风险-治疗悖论)，部分原因是没有意识到每个人的 CV风险，他们对预防干预的偏好，以及他们在每个人 日常生活。现有的实践指南建议临床医生和患者共同努力 为每个人的简历风险制定一个有效可行的预防计划 和知情偏好，这一过程被称为共享决策(SDM)。一个有效的和 评估个人简历风险并显示现有生活方式的影响和特点的创新工具 在临床接触期间使用的药物预防干预措施，以使 SDM是CV预防选择工具，但在实践中仍然很少使用。 我们的广泛目标是促进以患者为中心的护理，有效地减少实质性的 美国人的心血管疾病负担。这项研究直接回应PA-19-166，试图 确定实施方法，以促进有关初级心血管疾病预防的常规SDM 美国各地不同的初级保健做法。这项为期5年的研究-由 拥有预防心脏病学、SDM和实施科学专业知识的多学科团队 -将利用执行框架(执行综合框架 研究)、实施理论(标准化过程理论)和评估 框架(RE-AIM)设计、实施和报告混合方法、混合实施- 有效性(类型III)，阶梯-楔形分组随机试验，以确定： -执行效力(目标1)，通过评估实践背景和参与 用户在实施战略、实施成果(例如，覆盖范围、采用率)方面相关联 通过这些战略，以及实施如何促进SDM和简历的常规采用 初级保健实践中的预防选择工具，以及 -可持续发展管理有效性(目标2)，根据个人预防计划的程度进行评估 是可行的，与每个人估计的简历风险和偏好是一致的。 到项目结束时，我们希望(A)确定最有效的实施 将可持续发展管理纳入常规做法的战略和(B)估计可持续发展管理对 在初级保健中实现可行和风险一致的心血管疾病预防。

PROJECT SUMMARY/ABSTRACT The primary prevention of cardiovascular (CV) events is often more intense in individuals at lower risk and vice versa (risk-treatment paradox) in part due to unawareness of each person’s CV risk, of their preferences for prevention interventions, and of their feasibility in each person’s daily life. Extant practice guidelines recommend that clinicians and patients work together to arrive at an effective and feasible prevention plan that is congruent with each person’s CV risk and informed preferences, a process called shared decision making (SDM). An effective and innovative tool that estimates CV risk and shows the impact and features of available lifestyle and pharmacological preventive interventions for use during the clinical encounter to enable SDM, the CV Prevention Choice tool, is available yet remains rarely used in practice. Our broad goal is to promote patient-centered care that effectively reduces the substantial burden of CV disease among Americans. This study, directly responsive to PA-19-166, seeks to identify implementation approaches that foster routine SDM about primary CV prevention in a diverse set of primary care practices across the U.S. This 5-year study – proposed by a multidisciplinary team with expertise in preventive cardiology, SDM, and implementation science – will draw on an implementation framework (Consolidated Framework for Implementation Research), an implementation theory (Normalization Process Theory), and an evaluation framework (RE-AIM) to design, conduct, and report a mixed method, hybrid implementation- effectiveness (Type III), stepped-wedge clustered randomized trial to determine: - Implementation effectiveness (Aim 1) by evaluating practice contexts and engagement of users in implementation strategies, implementation outcomes (e.g., reach, adoption) associated with these strategies, and how implementation fosters routine adoption of SDM and the CV Prevention Choice tool in primary care practices, and - SDM effectiveness (Aim 2) estimated by the extent to which individual CV prevention plans are feasible and congruent with each person’s estimated CV risk and preferences. By the project’s end, we expect to have (a) identified the most effective implementation strategies to embed SDM in routine practice and (b) estimated the effectiveness of SDM to achieve feasible and risk-concordant CV prevention in primary care.