Closing the Research-To-Practice Gap in Cardiac Care Minority and Low Income Pop*

该提案描述了一个为期5年的培训计划，以促进卫生服务研究的学术生涯。主要研究者是密歇根州立大学（MSU）的普通内科医生和医学副教授，致力于作为独立卫生服务研究人员的职业发展。通过课程，研讨会和独立研究的结合，增强研究技能将在三个核心领域发展：预防心脏病学，决策支持工具的开发，以及非裔美国人（AA）和低社会经济地位（SES）冠心病人群的护理质量/过程改善。Margaret Holmes-Rovner博士将担任导师，她在决策辅助工具的开发和测试方面的工作享誉国际。金鹰，在质量改进研究和指导方针的实践应用的领导者，将共同导师。主要研究者（PI）现在工作，并将在密歇根州立大学有着悠久传统的领域开展拟议的工作：流行病学和卫生服务研究。这种环境提供了职业指导，正在进行的研究的批评，和研究组合的演变所需的频繁的互动。该研究将侧重于改善非裔美国人和低SES人群的冠心病（CHD）二级预防。该项目的具体目标是：1）通过使用联邦合格社区卫生中心（FICHCs）将成功的医院应用指南（GAP）调整为办公室实践（EST-GAP），改善CHD二级预防循证指南的实施。为了实现这一目标，我们将：a）开发EST-GAP工具，将二级预防的内容嵌入护理过程中，B）开发互动式教育会议，以实施以证据为基础、以患者为中心的沟通和工具使用方法。C）开发和实施一个系统，将患者与现有的社区资源联系起来。2)将决策支持工具集成到基于办公室的电子跟踪和提醒系统中，以加强医生和患者的二级预防目标。3)在密歇根州英厄姆县的CNOCHC站点展示CNO-GAP的可行性和有效性。

This proposal describes a 5-year training program to foster an academic career in health services research. The principal investigator is a general internist and Associate Professor of Medicine at Michigan State University (MSU) who is committed to career development as an independent health services researcher. Through a combination of coursework, seminars, and independent study, enhanced research skills will be developed in three core areas: preventive cardiology, development of decision support tools, and quality/process of care improvement for both African Americans (AA) and low socio-economic status (SES) populations with coronary heart disease. Dr. Margaret Holmes-Rovner, internationally known for her work in the development and testing of decision aids, will be the mentor. Dr. Kim Eagle, a leader in quality improvement research and application of guidelines to practice, will co-mentor. The primary investigator (PI) works now and will conduct the proposed work in an area where MSU has a strong tradition: epidemiology and health services research. This environment provides the frequent interactions needed for career guidance, critique of ongoing research, and evolution of a research portfolio. The research will focus on improving secondary prevention of coronary heart disease (CHD) for both African American and low SES populations. The Specific Aims of this project are to: 1) Improve the implementation of evidence-based guidelines for secondary prevention of CHD by adapting the successful hospital Guideline Applied to Practice (GAP) to office practice (Office-GAP) using Federally Qualified Community Health Centers (FQCHCs). To accomplish this aim we will: a) Develop Office-GAP tools to embed the content of secondary prevention into the care process, b) Develop interactive educational meetings for implementing evidence- based patient-centered methods for communication and tool use. C) Develop and implement a system to link patients with existing community resources. 2) Integrate Decision Support Tools into an office-based electronic tracking and reminder system to reinforce secondary preventive goals to physicians and patients. 3) Demonstrate the feasibility and effectiveness of Office-GAP in FQCHC sites in Ingham County, Michigan.