Study protocol for -Healthy Hearts Northwest-: a 2 × 2 randomized factorial trial to build quality improvement capacity in primary careReportar como inadecuado

Study protocol for -Healthy Hearts Northwest-: a 2 × 2 randomized factorial trial to build quality improvement capacity in primary care - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Implementation Science

, 11:138

First Online: 13 October 2016Received: 30 June 2016Accepted: 02 October 2016DOI: 10.1186-s13012-016-0502-7

Cite this article as: Parchman, M.L., Fagnan, L.J., Dorr, D.A. et al. Implementation Sci 2016 11: 138. doi:10.1186-s13012-016-0502-7


BackgroundLittle attention has been paid to quality improvement QI capacity within smaller primary care practices which comprise nearly half of all primary care settings. Strategies for external support to build such capacity include practice facilitation PF, shared learning opportunities, and educational outreach. Although PF has proven effectiveness, little is known about the comparative effectiveness of combining these strategies. Here, we describe the protocol of the -Healthy Hearts Northwest- H2N study, a randomized trial designed to address these questions while improving risk factors for cardiovascular disease.

Methods-designThe targeted enrollment is 250 smaller primary care practices across Washington, Oregon, and Idaho. The study is utilizing a two-by-two factorial design to assess four different combinations of practice support: PF alone, PF with educational outreach, PF with shared learning opportunities, or PF with both. A mixed methods approach is being used for evaluation and will include data from 1 baseline and follow-up practice and staff surveys; 2 baseline and quarterly clinical performance measurement from each practice on four cardiovascular risk factors: appropriate aspirin use, blood pressure control, lipid management and smoking cessation support; and 3 a quality improvement capacity assessment QICA survey used by external practice facilitators to guide improvement efforts.

DiscussionResults from this study will inform future large-scale practice improvement initiatives by providing comparisons of promising external practice support strategies and advance our understanding of how to build QI capacity in primary care.

Trial, NCT02839382

KeywordsPrimary health care Quality improvement Cardiovascular diseases AbbreviationsABCSAspirin, blood pressure, cholesterol, smoking

AHRQAgency for Healthcare Research and Quality

CPCQChange Process Capacity Questionnaire

CVDCardiovascular disease

EHRElectronic health record

H2NHealthy Hearts Northwest

LDLLow-density lipoprotein

NQFNational Quality Forum

ORPRNOregon Rural Practice Research Network

PFPractice facilitation

QIQuality improvement

QICAQuality improvement capacity assessment

USAUnited States of America

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Autor: Michael L. Parchman - Lyle J. Fagnan - David A. Dorr - Peggy Evans - Andrea J. Cook - Robert B. Penfold - Clarissa Hsu


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