Optimizing the Implementation of a Population Panel Management Intervention in Safety-Net Clinics for Childhood Hypertension

1.项目摘要/摘要 对于儿童高血压(HTN)，准确的诊断和最佳的临床处理是至关重要的。全国 指南是可用的，但儿童HTN的诊断经常被遗漏，治疗可能不会遵循 由于解释青年血压标准、诊断HTN和变量的复杂性而制定的指南 提供商对儿童期HTN的熟悉程度。有证据表明，广泛遵守HTN指南 会降低青少年的靶器官损害和HTN相关心血管疾病的风险 成人期。拟议项目的总体目标是优化一个有效和可行的 实施一揽子战略，以加强对儿童临床实践指南的遵守 HTN.拟议项目的核心是一个面向提供商的人口面板管理(PPM)工具，具有 临床决策支持。先前的研究表明，需要多个具体的实施战略来 学院实践和提供商级别的PPM工具采用。因此，我们将重点关注四大战略 类型：利益相关者参与、准备计划、培训以及持续的审计和反馈。该计划的目标是 拟议的项目是：目标1.完善处理多层次问题的人口小组管理工具 实施障碍；目标2.制定并优化多组成部分实施战略 一揽子计划；和目标3.评估实施的影响。使用参与式研究方法 涉及来自芝加哥联盟网络的一组利益相关者(医生、诊所经理) 社区卫生中心，根据科学顾问委员会的意见，我们将1)定制现有的PPM工具，以 遵守儿童HTN的最新指南；2)使用经过调整的概念图方法选择 实施战略，以支持该工具的采用；以及3)参与数据驱动的过程，以优化 解决改变指南相关医生的障碍和策略的有效性的战略方案 行为。我们将使用混合有效性实施试验设计和随机化部署 在总共24个实践中对每个连续的集群进行优化，以评估PPM工具对HTN的影响 在5至17岁的青少年中。主要结果是：实践者和提供者一级的指导性比率- 坚持HTN诊断和2)实施PPM工具的影响的关键指标和战略 在实践和提供商级别支持其使用的包。多层次执行成果评价 使用电子病历、调查和主要信息者访谈数据，将确定可接受性、采用率、适当性、 成本、可行性、保真度、覆盖范围和可持续性。拟议中的研究有改进的潜力。 通过实施以下措施，在高危青少年初级保健环境中识别、诊断和管理HTN 将EHR集成的PPM工具与临床决策支持结合使用的最佳实践指南。战略是否应该 儿童HTN采用PPM工具的包将成功，研究结果将可翻译到其他环境 以及影响整体人群健康的其他慢性心血管疾病的PPM。

1. Project Summary/Abstract For childhood hypertension (HTN), accurate diagnosis and optimal clinical management are essential. National guidelines are available, yet the diagnosis of HTN in childhood is often missed, and management may not follow guidelines due to the complexity of interpreting youth blood pressure standards, diagnosing HTN, and variable familiarity with childhood HTN among providers. Evidence suggests that wide adherence to HTN guidelines would result in lower risk among youths for target organ damage and HTN-related cardiovascular disease in adulthood. The overarching goal of the proposed project is to optimize an effective and feasible implementation strategy package to increase adherence to clinical practice guidelines for childhood HTN. The centerpiece of the proposed project is a provider-facing population panel management (PPM) tool with clinical decision support. Prior research indicates that multiple specific implementation strategies are needed to institute practice- and provider-level adoption of PPM tools. Consequently, we will focus on 4 broad strategy types: stakeholder involvement, readiness planning, training, and ongoing audit and feedback. The aims of the proposed project are: Aim 1. Refine a population panel management tool that addresses multilevel implementation barriers; Aim 2. Develop and then optimize a multicomponent implementation strategy package; and Aim 3. Evaluate the impact of the implementation. Using participatory research methods involving a group of stakeholders (physicians, practice managers) from the AllianceChicago network of community health centers, with input from a scientific advisory board, we will 1) tailor an existing PPM tool to adhere to the latest guidelines for childhood HTN; 2) use an adapted concept mapping approach for selection of implementation strategies to support adoption of the tool; and 3) engage in a data-driven process to optimize the strategy package to address barriers and effectiveness of the strategies in changing guideline-relevant physician behavior. We will use a hybrid effectiveness-implementation trial design with a randomized rollout for optimization with each successive cluster in 24 total practices, to evaluate the impact of the PPM tool for HTN among youth age 5 to 17 years. The principal outcomes are: practice- and provider-level 1) rates of guideline- adherent HTN diagnosis and 2) key indicators of the impact of implementing the PPM tool, and the strategy package to support its use, at the practice and provider levels. Multilevel implementation outcome evaluation using EHR, survey, and key informant interview data, will determine the acceptability, adoption, appropriateness, cost, feasibility, fidelity, reach, and sustainability. The proposed research has the potential to improve identification, diagnosis, and management of HTN in primary care settings for high-risk youth by implementing best practice guidelines using an EHR-integrated PPM tool with clinical decision support. Should the strategy package for PPM tool adoption be successful for childhood HTN, findings will be translatable to other settings and for PPM of other chronic cardiovascular conditions that affect overall population health.