Measure development to accelerate the translation of evidence based clinical guidelines into practice

抽象的。一半的美国成年人口有一个或多个可预防的心血管危险因素 疾病(CVD)，包括高血压(HTN)和高脂血症，但只有10%的人满足所有临床要求 由于指南推荐护理的采用不够理想而导致的目标。这在很大程度上是因为初级保健 实践和医疗保健系统正在努力确定哪种护理结构和 他们需要实施的流程才能成为高性能实践。这项提议的目标是 通过开发可靠、有效和实用的评估工具来解决这一翻译差距，该工具将确定 与心血管疾病相关结果的高绩效相关的初级保健做法的核心特征。尽管 大量关于实践改造和改进的研究，缺乏系统性和可扩展性 确定初级保健基础设施和流程的哪些功能与更好的 病人的结果。缺乏可靠的、有效的、实用的评估工具来定义实践变化 推动初级保健高绩效继续阻碍循证保健的实施 慢性病预防和将卫生保健创新转化为常规做法。因此，我们 在两个阶段的背景下，提出结合数据分析、调查技术的混合方法研究 德尔福流程和定性深度访谈，以描述和确定护理结构和 假设与心血管疾病相关的改善有关的流程(例如，决策支持) 病人的结果。然后，我们将开发和验证一种测量工具，用于确定护理结构中的差距 以及易于改变的过程，如果实施，将改善与心血管疾病相关的患者结局。 这项提议的一个优势是四个临床和翻译科学研究所之间的合作：(1)新的 纽约大学医学院(NYUSoM)-卫生与医院CTSI(NYU-H+H CTSI)，(2)俄勒冈州 健康与科学大学(OHSU)俄勒冈州临床翻译研究所(OCTRI)，(3)医学 南卡罗来纳大学南卡罗来纳临床翻译研究所，以及(4)南卡罗来纳临床翻译研究所 爱因斯坦和蒙特菲奥雷(卢旺达问题国际法庭)的临床和翻译研究，以及六个地理上不同的人 与国家实践网络合作，组成这一提案的研究团队。拟议的研究 意义重大，因为它将填补阻碍将医疗保健创新转化为 例行练习。因此，评估工具的使用结果将提供亟需的路线图 为实践转型、持续质量改进(即采用)建设能力和基础设施 和创新的可持续性)和改善人口健康。

ABSTRACT. Half of the U.S. adult population has one or more preventable risk factors for cardiovascular disease (CVD) including hypertension (HTN) and hyperlipidemia, but only 10% are meeting all of their clinical goals due to suboptimal adoption of guideline recommended care. This is largely because primary care practices and health care systems are struggling to identify which combination of care structures and processes they need to implement to become high performing practices. The objective of this proposal is address this translational gap by developing a reliable, valid, and pragmatic assessment tool that will identify core features of primary care practices that are related to high performance on CVD-related outcomes. Despite a large body of research on practice transformation and improvement, we lack a systematic and scalable approach to identifying which features of primary care infrastructure and processes are associated with better patient outcomes. This lack of a reliable, validated, pragmatic assessment tool to define the practice changes that drive high performance in primary care continues to impede implementation of evidence-based care for chronic disease prevention and the translation of innovations in health care into routine practice. We therefore propose a mixed-methods study combining data analytics, survey techniques in the context of a two-stage Delphi process and qualitative in-depth interviews to delineate and prioritize elements of care structure and processes (e.g., decision support) that are hypothesized to be associated with improvements in CVD-related patient outcomes. We will then develop and validate a measurement tool for identifying gaps in care structures and processes that are amenable to change, and if implemented, will improve CVD-related patient outcomes. A strength of this proposal is collaboration across four Clinical and Translational Science Institutes: (1) New York University School of Medicine (NYUSoM)-Health and Hospitals CTSI (NYU-H+H CTSI), (2) Oregon Health & Science University (OHSU) Oregon Clinical Translational Research Institute (OCTRI), (3) Medical University of South Carolina's South Carolina Clinical Translational Institute (SCTR), and (4) the Institute for Clinical and Translational Research at Einstein and Montefiore (ICTR), and six geographically diverse partnering national practice networks that will form the research team for this proposal. The proposed research is significant because it will fill a methodological gap that impedes translation of innovations in health care into routine practice. Findings from use of the assessment tool will therefore provide a much-needed roadmap for building capacity and infrastructure for practice transformation, continuous quality improvement (i.e., adoption and sustainability of innovation) and improvements in population health.