Achieving Outstanding Cardiovascular Health Outcomes for All Ohioans: a Statewide Cardiovascular Health Collaborative (Cardio-OH)

项目摘要 可改变的心血管疾病(CVD)危险因素，如高血压、胆固醇和 吸烟极大地增加了心血管疾病的发病率、死亡率和医疗费用。俄亥俄州在 心血管疾病发病率和死亡率的最高四分位数，在心血管疾病风险方面存在显著差异 按地理区域、种族/民族和保险类型划分的因素显示出显著的 改善的机会。我们建议使用一种独特的促进合作设计方法来 基于以患者为中心的结果研究(PCOR)开发心脏健康气质干预 在扩展的全州范围的俄亥俄州心血管健康协作(Cardi-OH)的背景下 加快全州范围内CVD的改善和缩小差距。这项建议的基础是 区域QI优势，以发展更大、更广泛和可持续的外部QI 通过将3个区域卫生改善协作组和7个区域改善协作组联系起来支持基础设施 在初级保健方面有更大的覆盖面和延伸，并与我们的 全州范围的合作，俄亥俄州心血管健康合作组织。 这个为期3年的项目有3个目标。对于目标1，我们建议在全州范围内扩大一个新生的 心血管健康协作，建立可持续的外部QI支持 基础设施。对于目标2，我们将共同设计、实施和评估有效性、采用率、 全面和分小组实施和维持心脏健康气质干预 (例如，地理、保险、种族/民族)使用组随机阶梯楔形设计。 对于目标3，我们将确定患者、提供者、诊所和其他相关背景因素 随着心脏健康QIP诊所心血管护理和结果的更大改善 我们将进行稳健的混合方法评估：1)Cardi-OH的进化，网络 发展、传播和可持续性；2)共同设计、采用、实施、 心脏健康QIP的整体和分小组的维护和有效性；以及3) 与心血管疾病危险因素流程改进的临床表现较好相关的因素。 项目结果将对政策制定者、健康保险公司、业务经理、健康 护理提供者和病人。这个项目可以提供一个变革性的和可持续的 全州范围内改善心血管健康和缩小差距的模式，通过 我们的混合方法评估，可以广泛分享，以供复制。

Project Summary Modifiable cardiovascular disease (CVD) risk factors such as hypertension, cholesterol and smoking contribute strongly to CVD morbidity, mortality, and health care cost. Ohio is in the highest quartile for CVD morbidity and mortality and has significant disparities in CVD risk factors by geographic region, race/ethnicity, and insurance type demonstrating substantial opportunity for improvement. We propose using a unique facilitated co-design approach to develop a heart healthy QI intervention based on patient-centered outcomes research (PCOR) in the context of an expanded statewide Ohio cardiovascular health collaborative (Cardi-OH) to accelerate statewide CVD improvement and reductions in disparities. This proposal builds on pockets of regional QI strengths to develop a larger, more extensive and sustainable external QI support infrastructure by linking the 3 Regional Health Improvement Collaboratives and 7 medical schools with greater reach and extension within primary care and linked to our statewide collaborative, the Ohio Cardiovascular Health Collaborative. This 3-year project has 3 aims. For Aim 1, we propose to expand a nascent statewide cardiovascular health collaborative and establish a sustainable external QI support infrastructure. For Aim 2 we will co-design, implement and evaluate the effectiveness, adoption, implementation, and maintenance of the heart healthy QI intervention overall and by subgroup (e.g., geography, insurance, race/ethnicity) using a group randomized stepped wedge design. And for Aim 3, we will determine patient, provider, clinic, and other contextual factors associated with greater improvements in cardiovascular care and outcomes at the heart healthy QIP clinics We will conduct a robust mixed methods evaluation of: 1) Cardi-OH’s evolution, network development, dissemination, and sustainability; 2) the co-design, adoption, implementation, maintenance and effectiveness of the heart healthy QIP overall and by subgroup ; and 3) the factors associated with better clinical performance on CVD risk factor process improvement. Project findings will be useful to policymakers, health insurers, practice managers, health care providers, and patients. This project could provide a transformative and sustainable statewide model for cardiovascular health improvement and disparity reduction which, through our mixed methods evaluation, can be shared broadly for replication.