Changes in the health care system are transforming existing models of cardiovascular disease management. Despite the disruption they will cause, these forces can potentially foster a new approach to cardiovascular disease that places prevention at the heart of patient-focused clinical practice. Harnessing these changes is not inevitable. Current mechanisms for reengineering care to meet these challenges are inadequate. This proposal seeks to train a young physician in the new sciences of change management. Through this award, Randall S. Stafford, MD, PhD will build on his experience in internal medicine, epidemiology and health care management to develop a research career committed to improving the quality of health care.
The aim of the proposed research is to use a data-driven, quantitative approach to design, implement and evaluate quality improvement efforts. It uniquely pairs analysis of national data with local clinical improvement initiatives. Data from the 1973-95 National Ambulatory Medical Care Surveys and the 1991-94 Medicare Current Beneficiary Surveys will be analyzed. This investigation will focus on cardiovascular disease prevention and treatment. Multivariate statistical analysis will test research hypotheses addressing: 1) the adequacy of current practices, 2) the role of race, gender, health insurance and physician specialty in practice patterns, and 3) the effectiveness of clinical guidelines. These results will be applied directly to local quality improvement initiatives. Local projects will be better able to prioritize problems, confront obstacles to quality practice, and identify methods of influencing physicians. The research environment for this proposal will encompass the Partners Health Care System (Massachusetts General Hospital [MGH] and Brigham and Women's Hospital). Research analysis will be carried out within the MGH General Internal Medicine Unit. Clinical improvement projects will include: 1) an initiative to increase the use of anticoagulation in atrial fibrillation, 2) enhancement of hospital critical pathways to emphasize prevention, 3) development and use of quality indicators for outpatient cardiovascular disease practices, and 4) evaluation of community-oriented initiatives to reduce ischemic heart disease risk in Charlestown, MA. These natural experiments will allow a rigorous examination of the effectiveness of quality improvement efforts. The most promising initiatives will form model systems that can be disseminated to other health care institutions to improve the quality of cardiovascular care.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HL003548-04
Application #
6030379
Study Section
Special Emphasis Panel (ZHL1-CSR-Y (M1))
Project Start
1996-07-01
Project End
2001-06-30
Budget Start
1999-09-05
Budget End
2000-06-30
Support Year
4
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02199
Stafford, Randall S (2003) Feedback intervention to reduce routine electrocardiogram use in primary care. Am Heart J 145:979-85
Huang, Elbert S; Stafford, Randall S (2002) National patterns in the treatment of urinary tract infections in women by ambulatory care physicians. Arch Intern Med 162:41-7
Ausiello, John C; Stafford, Randall S (2002) Trends in medication use for osteoarthritis treatment. J Rheumatol 29:999-1005
Thorndike, A N; Stafford, R S; Rigotti, N A (2001) US physicians' treatment of smoking in outpatients with psychiatric diagnoses. Nicotine Tob Res 3:85-91
Linder, J A; Stafford, R S (2001) Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. JAMA 286:1181-6
Wang, T J; Stafford, R S; Ausiello, J C et al. (2001) Randomized clinical trials and recent patterns in the use of statins. Am Heart J 141:957-63
Stafford, R S; Farhat, J H; Misra, B et al. (2000) National patterns of physician activities related to obesity management. Arch Fam Med 9:631-8
Stafford, R S (2000) Aspirin use is low among United States outpatients with coronary artery disease. Circulation 101:1097-101
Meigs, J B; Stafford, R S (2000) Cardiovascular disease prevention practices by U.S. Physicians for patients with diabetes. J Gen Intern Med 15:220-8
Thorndike, A N; Ferris, T G; Stafford, R S et al. (1999) Rates of U.S. physicians counseling adolescents about smoking. J Natl Cancer Inst 91:1857-62

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