: This project will demonstrate and evaluate the translation of the ATP III Cholesterol management guidelines into primary care practice. During phase 1, a needs assessment will evaluate barriers and facilitators to implementation of ATP III guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from semi-structured individual interviews of patients and providers and participant observation during pilot testing in 10 primary care practices, three tools will be refined and tailored: a computerized patient activation tool based upon NHLBI web-based 10-year CHD risk score that will be placed in each primary care office's waiting room for patient use; an ATP III interactive guidelines tool for hand held device (PDA) to be used by primary care providers as a decision support tool at the point of care and academic detailing materials consisting of a practice manual, interactive, powerpoint slides, and practice materials to be used during a academic detailing session. During phase 2, a block, randomized designed cluster trial will be performed with one year of intervention within primary care practices (24 practices/48 providers) throughout the state of Rhode Island and Southeastern New England to test the effectiveness of the materials developed in phase 1 to improve physician performance around ATP III guideline implementation and to improve clinically relevant outcomes, the percentage of patients with LDL-cholesterol at their ATP III goal. Products for dissemination from this grant will include the results of the focus groups barriers and facilitators to implementation of ATP III guidelines findings, a MedQuest module for quality of care assessment regarding ATP III guidelines, refined computerized patient activation tool, tailored ATP III interactive guideline tool for PDA, tailored academic detailing materials and results of randomized clinical trial on the effectiveness of these tools to improve primary care practice.
