Midwest Small Practice Care Transformation Research Alliance

 描述(由申请人提供)：尽管质量改进策略已被证明可以改善心血管疾病ABC的护理(即阿司匹林处方、血压控制、胆固醇管理和戒烟咨询)，但这些策略的大多数研究都是在资源充足的学术机构或综合医疗保健提供系统中进行的。目前尚不清楚这些战略能否在资源更有限、质量改进基础设施不发达的独立初级保健实践中有效实施。我们建议将覆盖伊利诺伊州东北部的四个区域推广中心(REC)整合在一起，包括芝加哥、威斯康星州东南部和印第安纳州西北部，构成密歇根湖沿岸人口稠密的三州走廊，总共为300多家初级保健诊所提供服务。我们的多方利益相关者团队包括州公共卫生部、美国医学会、芝加哥联盟、伊利诺伊州特利根的联邦医疗保险质量改进组织和转移(威斯康星州的QIO和REC)，以测试在EHR启用的初级保健实践中，护理点(POC)策略(即访问时)和人口管理(PM)策略(即基于系统的预防和临床护理方法)的可行性和有效性。我们将评估我们地区小型实践实施POC和PM质量改进战略以改善ABC的能力，并实施开源的PopHealth绩效测量软件来评估ABC的绩效并实现区域基准。我们将进行一项实践随机试验，以确定与基准相比，PoC策略是否改善了ABC的绩效指标，以及将本地定制的PM策略添加到PoC策略中是否比单独使用POC策略更好地改善了ABC的绩效。最后，我们将部署一个开源质量测量平台(PopHealth)，以参与实践的ABC测量为基础建立区域QI基准，并支持对整个地区的电子临床质量测量(ECQM)进行纵向跟踪。我们将进行混合方法评估，以检查实践者感知的质量改进能力的变化，以及对区域内比较质量数据的访问是否提高了实践者维持其围绕ABC的质量改进计划的能力，并为实践者实施新的QI活动提供了长期框架。我们的计划将创建一个强大和可持续的质量改进基础设施，旨在将PCOR的调查结果有效地转化为区域内的初级保健实践。

 DESCRIPTION (provided by applicant): Although quality improvement strategies have been shown to improve care around the ABCS of cardiovascular disease (i.e. aspirin prescribing, blood pressure control, cholesterol management, and smoking cessation counseling), most studies of these strategies have been conducted in well-resourced academic institutions or integrated healthcare delivery systems. It is unclear whether these strategies can be effectively implemented in independent primary care practices with more limited resources and less developed quality improvement infrastructure. We propose to bring together the four Regional Extension Centers (RECs) covering Northeastern Illinois including Chicago, Southeastern Wisconsin, and Northwest Indiana, constituting the populous Tri-State corridor along Lake Michigan and collectively serving over 300 primary care practices. Our multi-stakeholder team includes State Departments of Public Health, the American Medical Association, the Alliance of Chicago, Telligen, Illinois' Medicare Quality Improvement Organization and Metastar (the QIO and REC for Wisconsin), to test the feasibility and effectiveness of point of care (POC) strategies (i.e., at the time of a visit) and population-management (PM) strategies (i.e. systems-based approaches to preventive and clinical care,) in EHR-enabled primary care practices. We will evaluate the ability of small practices in our region to implement POC and PM quality improvement strategies to improve the ABCS and implement the open source PopHealth performance measurement software to evaluate performance on the ABCS and enable regional benchmarking. We will conduct a practice-randomized trial to determine whether POC strategies improve ABCS performance measures compared to baseline, and whether adding locally-tailored PM strategies to POC strategies improves performance on the ABCS measures more than POC strategies alone. Finally, we will deploy an open source quality measurement platform (PopHealth) to establish a regional QI benchmarch based on participating practice ABCS measures and enable longitudinal tracking of electronic clinical quality measures (eCQMs) across our region. We will perform a mixed-methods evaluation to examine changes in practices' perceived capacity for quality improvement and whether access to comparative quality data within a region improves the capacity of practices to sustain their quality improvement program around the ABCS and provides a long term framework for practices to implement new QI activities. Our program will create a robust and sustainable quality improvement infrastructure positioned to translate PCOR findings efficiently into primary care practices within a region.