PRIMARY AND SECONDARY PREVENTION OF CHD AND STROKE

该应用程序的主要目的是研究质量改进模型的影响，该模型使用学术细节和电子病历（EMR）对遵守初级保健环境中预防心血管疾病和中风的临床实践指南。本研究的长期目标是验证一种在初级保健中实施循证医学的方法，使用信息工具和行为改变理论相结合的方法。来自南卡罗来纳州医科大学卫生保健研究中心（CHCR）的研究人员将在美国22个附属的实践合作伙伴研究网络（pPRNet）网站进行这项研究。项目调查人员已经开发和完善了模型，在以前的研究中，在这个应用程序中进行测试。该模型被称为“通过电子病历（QIT-EMR）进行质量改进”。“研究的一级预防指南将是高血压筛查和高血压控制，高脂血症筛查和绝经后女性的激素替代治疗。二级预防指南将是冠心病（CHD）和糖尿病（DM）患者的降胆固醇治疗、有心肌梗死病史的患者的β受体阻滞剂治疗、心力衰竭患者的血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂治疗、房颤患者的口服抗凝治疗以及DM患者的血糖和血压控制。该研究将是一项为期三年的随机对照临床试验。它将测试的假设，接受QIT-EMR模型干预的做法将有更大的改善，在接受一级和二级预防干预的患者比例，并实现目标的结果比比较的做法。研究数据将从各研究实践的现有EMR中获得。对照组实践将收到有关临床实践指南的信息，以及详细说明其遵守情况的季度报告。干预组实践将收到相同的信息，并参加研究者的四次实践现场访视，三次研究者会议，以及实施QIT-EMR模型的持续沟通。将对干预措施进行形成性评价。在试验结束时，将评估干预的影响和成本。

The principal aim of the application is to study the impact of a quality improvement model using academic detailing and electronic medical records (EMR) on adherence with clinical practice guidelines for prevention of cardiovascular disease and stroke in primary care settings. The long-term objective of the research is to validate a method implementing evidence- based medicine in primary care, using an approach combining information tools and behavioral change theory. Investigators from the Medical University of South Carolina's Center for Health Care Research (CHCR) will conduct the study in 22 affiliated Practice Partner Research Network (pPRNet) sites across the United States. Project investigators have developed and refined the model to be tested in this application in previous research. The model is termed "Quality Improvement through Electronic Medical Records (QIT-EMR)." The primary prevention guidelines studied will be screening for hypertension and hypertension control, screening for hyperlipidemia, and hormone replacement therapy for postmenopausal females. The secondary prevention guidelines will be cholesterol lowering for patients with coronary heart disease (CHD) and diabetes mellitus (DM), beta-blockers for patients with a history of myocardial infarction, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers for patients with heart failure, oral anticoagulant therapy for patients with atrial fibrillation, and glycemic and blood pressure control in patients with DM. The study will be a three-year randomized controlled clinical trial. It will test the hypothesis that practices that receive the QIT-EMR model interventions will have greater improvement in the proportion of patients who receive the primary and secondary preventive interventions and achieve target outcomes than do comparison practices. Data for the study will be obtained from the existing EMR at each study practice. Control group practices will receive information about the clinical practice guidelines, and quarterly reports detailing their adherence with them. Intervention group practices will receive identical information and participate in four practice site visits by study investigators, three investigator meetings, and ongoing communication to implement the QIT-EMR model. A formative evaluation of the interventions will be conducted. At the conclusion of the trial, the impact and cost of the intervention will be assessed.