The Alabama Cardiovascular Cooperative: Supporting Cardiovascular Risk Reduction in Primary Care

在美国，在过去的三十年里， (CVD)然而，在风险和死亡率方面，这些成果并不是在全国所有地区都是一致的。不平等 心血管结局仍然存在，在某些情况下，在种族，社会经济和 地理线。在美国东南部，中风、心肌梗死（MI）、糖尿病和肥胖的发病率是 是全国最高的根据millionhearts.org的数据，亚拉巴马的失业率最高， 所有50个州的CVD事件（死亡、住院、艾德访视）。虽然循证指南 尽管存在筛查和治疗心血管危险因素的措施，但实施往往不理想。许多因素 造成研究与实践之间的差距，包括教育缺陷、提供者的时间限制， 缺乏反馈机制和决策支持工具，以及文化因素和组织氛围。 如果为初级保健提供者和患者提供工具， 解决心血管健康问题（即，评估和管理心血管风险），特别是在南部农村。 通过这项申请，我们提议成立亚拉巴马心血管合作组织， 协调全州的努力，以改善心血管疾病的风险和减少差距。合作伙伴包括5 长期致力于改善亚拉巴马全州健康状况的组织 覆盖面，以及共同的信念，即协调努力，支持以初级保健为基础的倡议，以改善心血管疾病 亚拉巴马州的卫生可能会带来变革;这些实体包括亚拉巴马州公共卫生部 （ADPH），亚拉巴马质量保证基金会（AQAF），亚拉巴马初级卫生保健协会 （APHCA）、奥本大学药学院和亚拉巴马大学伯明翰分校药学院 医学（UAB）。我们将在一个可持续的，以心血管疾病为重点的 “实践社区”。我们将在60个初级保健诊所实施心脏健康改善项目， 血压（BP）控制和吸烟状况筛查的次优率，使用3项 方法包括实践促进和技术援助，在线和电子学习，以及改进 通过数据透明度。我们将使用I型混合设计，同时测试 对BP和吸烟相关结果进行干预，同时收集实施信息。的 成果评估将以普罗克特的《实施成果框架》为指导，我们将 使用实施研究综合框架评估实施情况。通过这些 通过协调一致的努力，我们的首要目标是推动亚拉巴马走出心血管疾病的最低四分之一 减少城乡差距和种族差距。

In the United States (U.S.), the last three decades have seen vast improvements in cardiovascular disease (CVD) risk and mortality, however, these gains are not consistent across all regions of the country. Inequities in cardiovascular outcomes remain, and in some cases have widened, across racial, socio-economic, and geographic lines. In the Southeastern U.S., rates of stroke, myocardial infarction (MI), diabetes and obesity are among the highest in the nation. According to data from millionhearts.org, Alabama has the highest rate of CVD events (death, hospitalizations, ED visits) among all 50 states. Although evidence-based guidelines for screening and treatment of cardiovascular risk factors exist, implementation is often suboptimal. Many factors contribute to the research-to-practice gap, including educational deficiencies, time constraints for providers, lack of feedback mechanisms and decision support tools, as well as cultural factors and organizational climate. There is potential for real impact in CVD health if primary care providers and patients are provided with tools to address cardiovascular health (i.e., assess and manage cardiovascular risks), particularly in the rural south. With this application, we propose the creation of the Alabama Cardiovascular Cooperative to promote coordination of statewide efforts to improve cardiovascular risk and reduce disparities. Partners include 5 organizations with long-standing commitments to improving health outcomes in Alabama, broad statewide reach, and a shared belief that a coordinated effort to support primary care-based initiatives to improve CVD health in Alabama could prove transformative; these entities include the Alabama Department of Public Health (ADPH), the Alabama Quality Assurance Foundation (AQAF), the Alabama Primary Health Care Association (APHCA), Auburn University School of Pharmacy, and the University of Alabama at Birmingham School of Medicine (UAB). We will engage primary care practices from across the state in a sustainable, CVD-focused “community of practice.” We will implement a Heart Health Improvement project in 60 primary care clinics with suboptimal rates of blood pressure (BP) control and screening for smoking status using a 3-prongued approach comprising Practice Facilitation & Technical Assistance, Online & eLearning, and Improvement through Data Transparency. We will use a Type I hybrid design, to simultaneously test the effects of the intervention on BP and smoking-related outcomes while also gathering information on implementation. The outcomes evaluation will be guided by the Proctor’s Framework for Implementation Outcomes, and we will assess implementation using the Consolidated Framework for Implementation Research. Through these coordinated efforts, our overarching goal is to propel Alabama out of the bottom quartile for cardiovascular outcomes and reduce rural/urban and racial disparities.