Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYCReportar como inadecuado




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Implementation Science

, 11:88

First Online: 04 July 2016Received: 25 May 2016Accepted: 07 June 2016DOI: 10.1186-s13012-016-0450-2

Cite this article as: Shelley, D.R., Ogedegbe, G., Anane, S. et al. Implementation Sci 2015 11: 88. doi:10.1186-s13012-016-0450-2

Abstract

BackgroundHealthyHearts NYC HHNYC will evaluate the effectiveness of practice facilitation as a quality improvement strategy for implementing the Million Hearts’ ABCS treatment guidelines for reducing cardiovascular disease CVD among high-risk patients who receive care in primary care practices in New York City. ABCS refers to A aspirin in high-risk individuals; B blood pressure control; C cholesterol management; and S smoking cessation. The long-term goal is to create a robust infrastructure for implementing and disseminating evidence-based practice guidelines EBPG in primary care practices.

Methods-designWe are using a stepped-wedge cluster randomized controlled trial design to evaluate the implementation process and the impact of practice facilitation PF versus usual care on ABCS outcomes in 250 small primary care practices. Randomization is at the practice site level, all of which begin as part of the control condition. The intervention consists of one year of PF that includes a combination of one-on-one onsite visits and shared learning across practice sites. PFs will focus on helping sites implement evidence-based components of patient-centered medical home PCMH and the chronic care model CCM, which include decision support, provider feedback, self-management tools and resources, and linkages to community-based services.

DiscussionWe hypothesize that practice facilitation will result in superior clinical outcomes compared to usual care; that the effects of practice facilitation will be mediated by greater adoption of system changes in accord with PCMH and CCM; and that there will be increased adaptive reserve and change capacity.

Trial registrationNCT02646488

KeywordsPractice facilitation Primary care Cardiovascular disease  Download fulltext PDF



Autor: Donna R. Shelley - Gbenga Ogedegbe - Sheila Anane - Winfred Y. Wu - Keith Goldfeld - Heather T. Gold - Sue Kaplan - Caro

Fuente: https://link.springer.com/







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