Inadequate implementation of guidelines for prevention of cardiovascular disease (CVD) in primary care settings, particularly those serving low-income and minority populations, has contributed to persistent disparities in CVD-related morbidity and mortality. The objective of this proposal is to fill this current research-to-practic gap by testing the effectiveness of practice facilitation as a quality improvement strategy for implementing evidence-based guidelines for reducing CVD-related risk factors in primary care practices in New York City. The specific focus, of this proposal is to improve adherence to the ABCS - Aspirin (A) in high-risk individuals, Blood pressure control (B), Cholesterol management (C), and Smoking cessation (S). The long-term goal is to create a robust infrastructure to disseminate and implement Patient Centered Outcomes Research (PCOR) findings in primary care practices and improve practices' capacity to implement other PCOR findings in the future. Recent systematic reviews demonstrate that interventions with proven effectiveness in promoting the implementation of evidence-based research are tailored to the practice context and involve a multicomponent approach based on the Chronic Care Model (CCM). Most practices, however, lack the resources and expertise to coordinate a complex set of multilevel system changes without assistance. One implementation strategy that may effectively overcome these barriers is practice facilitation (PF). PF provides external expertise on practice redesign i accord with the CCM, and promotes a tailored approach to implementing guideline-concordant care to improve patient outcomes. We therefore propose to study the impact of PF on CVD-related outcomes by employing a stepped-wedge design in which 250 EHR-enabled small to medium primary care sites are enrolled into the control at the same time and then randomly assigned to cross over into the intervention condition at three month intervals with all sites eventually receiving the intervention. The primary outcome is the proportion of patients that have reached clinical goals for the ABCSs. The significance of this proposal and potential for large-scale dissemination of findings is enhanced by the unique partnership between NYUSOM, and the NYC Department of Health (NYCDOH) Primary Care Improvement Program (PCIP), with over 3000 small to medium sized primary care practices in their regional extension center and the Community Health Care Association of New York State (CHCANYS), one of the premiere not-for-profit primary care associations in the country. The proposal leverages PCIP and CHCANY's robust information technology infrastructure and efficiencies offered by their centralized data warehouses with capacity for data collection across diverse settings with different EHRs. The project is expected to provide critical new knowledge to facilitate the widespread implementation, dissemination and sustained utilization of evidence- based guidelines for prevention of CVD across the U.S.
Cardiovascular disease (CVD) is the number one cause of preventable death in the U.S. Guidelines for reducing risk factors for CVD, like hypertension, hyperlipidemia and smoking exist, but they are not well integrated into primary care practice. We will study strategies that promise to increase implementation and dissemination of guidelines for reducing the risk of CVD in primary care settings serving those populations most at risk for CVD-related mortality. The potential population health impact of fully implementing CVD- related practice guidelines, particularly in health centers serving disparate populations, is substantial.
| Shelley, Donna; Blechter, Batel; Siman, Nina et al. (2018) Quality of Cardiovascular Disease Care in Small Urban Practices. Ann Fam Med 16:S21-S28 |
| Shelley, Donna R; Ogedegbe, Gbenga; Anane, Sheila et al. (2016) Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC. Implement Sci 11:88 |
