Dissemination of CVD risk factor treatment among diabetic patients in FQHCs

描述（由申请人提供）：我们提出了一个示范和传播项目，扩展心血管疾病的风险降低计划，证明是有效的糖尿病（DM）患者在综合HMO人口，一个脆弱的门诊人口接受DM护理在11个联邦合格的健康中心（NHHC）诊所在波特兰，或大都市区。患有糖尿病和其他危险因素的成年人服用阿司匹林、他汀类药物和ACE抑制剂可以将心血管事件的风险降低多达40%;拟议的研究将调整Kaiser Permanente使用的干预策略，以增加研究诊所中使用这些药物的糖尿病患者的百分比。干预策略源自慢性病护理模式，包括基于初级护理团队的护理，积极的病例管理，社区诊所常见的电子病历（EMR）中内置的临床提示，将药房数据集与EMR相关联以监测患者依从性，以及优先考虑对风险最大的患者进行临床随访的小组报告工具。我们将通过测量DM人群目标药物处方率的变化和处方补充率的变化，使用诊所内的前后比较和诊所间的交错随机实施，确定干预措施传播的有效性及其对患者依从性的影响。我们还将进行一次进程评价，以确定对传播和执行工作取得成功至关重要的因素。我们的总体目标是确定和解决从一个大型的，组织良好的卫生系统传播到社区诊所的成功计划的问题，使该计划可以在其他社区卫生中心和实践环境中更广泛地实施适度的EMR基础设施资源。这项研究将为未来利用安全网诊所的EMR传播循证护理的研究铺平道路。 公共卫生相关性：患有糖尿病的成年人服用阿司匹林，他汀类药物和ACE抑制剂可以显着降低心血管事件的风险。因此，五年前，Kaiser Permanente（KP）发起了一项倡议，让尽可能多的糖尿病患者接受这种药物治疗，使用电子病历来识别未服用药物的患者，并提醒临床医生开始这些患者的药物治疗;此外，初级保健病例管理团队联系了符合条件的患者。我们建议在俄勒冈州的11个社区卫生中心实施类似的计划，以评估KP的计划是否可以在这些环境中成功传播，以及它是否可以影响处方和补充目标药物的合格患者的百分比。

DESCRIPTION (provided by applicant): We propose a demonstration and dissemination project that extends a cardiovascular disease risk-reduction program shown to be effective among patients with Diabetes Mellitus (DM) in an integrated HMO population, to a vulnerable outpatient population receiving DM care in 11 Federally Qualified Health Center (FQHC) clinics in the Portland, OR metropolitan area. Adults with DM and other risk factors who take aspirin, statins, and ACE Inhibitors can reduce their risk of cardiovascular events by as much as 40%; the proposed study will adapt intervention strategies used by Kaiser Permanente to increase the percentage of DM patients on these medications in the study clinics. Intervention strategies derive from the Chronic Care Model and include primary-care-team-based care, active case management, clinical prompts built into the electronic medical record (EMR) common to the community clinics, linked pharmacy datasets with the EMR to monitor patient adherence, and a panel reporting tool that prioritizes clinical follow-up to those most at risk. We will determine the effectiveness of the dissemination of the intervention, and its impact on patient adherence, by measuring changes in DM population prescription rates for the target medications and changes in prescription refill rates, using a pre- post comparison within clinics and a staggered, randomized implementation across clinics. We will also conduct a process evaluation to identify the factors important to dissemination and implementation success. Our overarching goals are to identify and resolve issues in disseminating a successful program from a large, well-organized health system into community clinics, so that the program may be implemented more widely in other community health centers and practice settings with modest EMR infrastructure resources. The proposed study will pave the way for future research on disseminating evidence-based care using safety net clinics' EMR. PUBLIC HEALTH RELEVANCE: Adults with diabetes who take aspirin, statins, and ACE Inhibitors can dramatically reduce their risk of cardiovascular events. Therefore, five years ago Kaiser Permanente (KP) launched an initiative to put as many of its members with diabetes as possible on this drug regimen, using the electronic medical record to identify patients not taking the medications, and to remind clinicians to start these patients on the medications; in addition, primary care case management teams contacted eligible patients. We propose to implement a similar program in eleven of Oregon's community health centers, to assess whether KP's program can be successfully disseminated in those settings, and whether it can impact the percentage of eligible patients who are prescribed and refill the target medications.