This proposal describes a 5-year training program to foster an academic career in health services research. The principal investigator is a general internist and Associate Professor of Medicine at Michigan State University (MSU) who is committed to career development as an independent health services researcher. Through a combination of coursework, seminars, and independent study, enhanced research skills will be developed in three core areas: preventive cardiology, development of decision support tools, and quality/process of care improvement for both African Americans (AA) and low socio-economic status (SES) populations with coronary heart disease. Dr. Margaret Holmes-Rovner, internationally known for her work in the development and testing of decision aids, will be the mentor. Dr. Kim Eagle, a leader in quality improvement research and application of guidelines to practice, will co-mentor. The primary investigator (PI) works now and will conduct the proposed work in an area where MSU has a strong tradition: epidemiology and health services research. This environment provides the frequent interactions needed for career guidance, critique of ongoing research, and evolution of a research portfolio. The research will focus on improving secondary prevention of coronary heart disease (CHD) for both African American and low SES populations.
The Specific Aims of this project are to: 1) Improve the implementation of evidence-based guidelines for secondary prevention of CHD by adapting the successful hospital Guideline Applied to Practice (GAP) to office practice (Office-GAP) using Federally Qualified Community Health Centers (FQCHCs). To accomplish this aim we will: a) Develop Office-GAP tools to embed the content of secondary prevention into the care process, b) Develop interactive educational meetings for implementing evidence- based patient-centered methods for communication and tool use. C) Develop and implement a system to link patients with existing community resources. 2) Integrate Decision Support Tools into an office-based electronic tracking and reminder system to reinforce secondary preventive goals to physicians and patients. 3) Demonstrate the feasibility and effectiveness of Office-GAP in FQCHC sites in Ingham County, Michigan.