Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Study protocol

Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma

Authors: Ann F. Chou, Juell B. Homco, Zsolt Nagykaldi, James W. Mold, F. Daniel Duffy, Steven Crawford, Julie A. Stoner

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Cardiovascular disease (CVD) is the leading cause of death in the US and incurs high health care costs. While many initiatives promote the implementation of ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) measures, most primary care practices (PCPs) lack quality improvement (QI) support and resources to achieve meaningful targets. The Healthy Hearts for Oklahoma (H2O) Study proposes to build a QI infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; (2) providing QI support in PCPs to better manage patients at risk for CVD events. Parallel to infrastructure building, H2O aims to conduct a comprehensive evaluation of the QI support D&I in primary care and assess the relationship between QI support uptake and changes in ABCS measures.

Methods

H2O has partnered with public health agencies and communities to build OPHIC and facilitate QI. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS performance. A stepped-wedge designed is used to evaluate D&I of QI support. Changes in ABCS measures will be estimated as a function of various components of the QI support and capacity and readiness of PCPs to change. Notes from academic detailing and practice facilitation sessions will be analyzed to help interpret findings on ABCS performance.

Discussion

H2O program is designed to improve cardiovascular health and outcomes for more than 1.25 million Oklahomans. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations. Lessons learned from this project will guide future strategies for D&I of evidence-based practices in PCPs. Trained practice facilitators will continue to serve as critical resource to assists small, rural PCPs in adapting to the ever-changing health environment and continue to deliver quality care to their communities.
Appendix
Available only for authorised users
Literature
1.
Frieden TR, Berwick DM. The “Million Hearts” initiative--preventing heart attacks and strokes. N Engl J Med. 2011;365(13):e27.CrossRefPubMed
2.
Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.CrossRefPubMed
3.
American Health Rankings. The United Health Foundation; 2016.
4.
Center for Health Statistics, Oklahoma State Department of Health (OSDH). Vital Statistics 2014. Oklahoma Statistics on Health Available for Everyone (OK2SHARE). 2014.
5.
Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388–98.CrossRefPubMed
6.
Wright J. Status of ABCS. Centers for Medicare and Medicaid Services (CMS); 2014.
7.
CDC. Vital signs: awareness and treatment of uncontrolled hypertension among adults--United States, 2003-2010. MMWR. 2012;61:703.
8.
Muntner P, Levitan EB, Brown TM, Sharma P, Zhao H, Bittner V, Glasser S, Kilgore M, Yun H, Woolley JM, et al. Trends in the prevalence, awareness, treatment and control of high low density lipoprotein-cholesterol among United States adults from 1999-2000 through 2009-2010. Am J Cardiol. 2013;112(5):664–70.CrossRefPubMedPubMedCentral
9.
Rodriguez CJ, Cai J, Swett K, Gonzalez HM, Talavera GA, Wruck LM, Wassertheil-Smoller S, Lloyd-Jones D, Kaplan R, Daviglus ML. High cholesterol awareness, treatment, and control among Hispanic/Latinos: Results from the Hispanic Community Health Study/Study of Latinos. J Am Heart Assoc. 2015;4(7)
10.
11.
Goldstein MG, Niaura R, Willey C, Kazura A, Rakowski W, DePue J, Park E. An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: smoking cessation outcomes of the Physicians Counseling Smokers Project. Prev Med. 2003;36(2):185–96.CrossRefPubMed
12.
Ilett KF, Johnson S, Greenhill G, Mullen L, Brockis J, Golledge CL, Reid DB. Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer). Br J Clin Pharmacol. 2000;49(2):168–73.CrossRefPubMedPubMedCentral
13.
Young JM, Ward JE. Randomised trial of intensive academic detailing to promote opportunistic recruitment of women to cervical screening by general practitioners. Aust N Z J Public Health. 2003;27(3):273–81.CrossRefPubMed
14.
Brown JB, Shye D, McFarland BH, Nichols GA, Mullooly JP, Johnson RE. Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression. Jt Comm J Qual Improv. 2000;26(1):39–54.PubMed
15.
Thomson O’Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000;2:CD000409.
16.
Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;2:CD000259.
17.
Kanouse DE, Jacoby I. When does information change practitioners’ behavior? Int J Technol Assess Health Care. 1988;4(1):27–33.CrossRefPubMed
18.
Kiefe CI, Allison JJ, Williams OD, Person SD, Weaver MT, Weissman NW. Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA. 2001;285(22):2871–9.CrossRefPubMed
19.
Thomson O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000;2:CD000260.
20.
21.
Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. Arch Surg. 2002;137(1):20–7.CrossRefPubMed
22.
Krakauer H, Lin MJ, Schone EM, Park D, Miller RC, Greenwald J, Bailey RC, Rogers B, Bernstein G, Lilienfeld DE, et al. ‘Best clinical practice’: assessment of processes of care and of outcomes in the US Military Health Services System. J Eval Clin Pract. 1998;4(1):11–29.CrossRefPubMed
23.
Mold JW, Gregory ME. Best practices research. Fam Med. 2003;35(2):131–4.PubMed
24.
Oddone E, Brass LM, Booss J, Goldstein L, Alley L, Horner R, Rosen A, Kaplan L. Quality Enhancement Research Initiative in stroke: prevention, treatment, and rehabilitation. Med Care. 2000;38(6 Suppl 1):I92–104.PubMed
25.
Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med. 2012;10(1):63–74.CrossRefPubMedPubMedCentral
26.
Nagykaldi Z, Mold JW, Aspy CB. Practice facilitators: a review of the literature. Fam Med. 2005;37(8):581–8.PubMed
27.
Nagykaldi Z, Mold JW, Robinson A, Niebauer L, Ford A. Practice facilitators and practice-based research networks. J Am Board Fam Med. 2006;19(5):506–10.CrossRefPubMed
28.
Rogers EM. Diffusion of innovations, 5th ed. New York: Free Press; 2003.
29.
Rasmussen WD. Taking the university to the people : seventy-five years of cooperative extension. 1st ed. Ames: Iowa State University Press; 1989.
30.
Hogg W, Baskerville N, Lemelin J. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis. BMC Health Serv Res. 2005;5(1):20.CrossRefPubMedPubMedCentral
31.
Nagykaldi Z, Mold JW. The role of health information technology in the translation of research into practice: an Oklahoma Physicians Resource/Research Network (OKPRN) study. J Am Board Fam Med. 2007;20(2):188–95.CrossRefPubMed
32.
33.
34.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.CrossRefPubMedPubMedCentral
35.
Langley GJ. The improvement guide : a practical approach to enhancing organizational performance. 1st ed. San Francisco: Jossey-Bass Publishers; 1996.
36.
Solberg LI, Brekke ML, Fazio CJ, Fowles J, Jacobsen DN, Kottke TE, Mosser G, O'Connor PJ, Ohnsorg KA, Rolnick SJ. Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv. 2000;26(4):171–88.PubMed
37.
38.
Solberg LI, Stuck LH, Crain AL, Tillema JO, Flottemesch TJ, Whitebird RR, Fontaine PL. Organizational factors and change strategies associated with medical home transformation. Am J Med Qual. 2015;30(4):337–44.CrossRefPubMed
39.
Solberg LI, Asche SE, Margolis KL, Whitebird RR. Measuring an organization's ability to manage change: the change process capability questionnaire and its use for improving depression care. Am J Med Qual. 2008;23(3):193–200.CrossRefPubMed
40.
Nutting PA, Crabtree BF, Stewart EE, Miller WL, Palmer RF, Stange KC, Jaen CR. Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home. Ann Fam Med. 2010;8(Suppl 1):S33–44. S92
41.
Dimairo MB, Walters M, Stephen J. Sample size determination through power simulation; practical lessons from a stepped wedge cluster randomised trial (SW CRT). Trials. 2011;12(Suppl 1)
42.
Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007;28(2):182–91.CrossRefPubMed
43.
Thompson DM, Fernald DH, Mold JW. Intraclass correlation coefficients typical of cluster-randomized studies: estimates from the Robert Wood Johnson Prescription for Health projects. Ann Fam Med. 2012;10(3):235–40.CrossRefPubMedPubMedCentral
44.
45.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.CrossRefPubMed
46.
47.
48.
2011 National Healthcare Quality Report In.: Agency for Healthcare Research and Quality 2012.
Metadata
Title
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma
Authors
Ann F. Chou
Juell B. Homco
Zsolt Nagykaldi
James W. Mold
F. Daniel Duffy
Steven Crawford
Julie A. Stoner
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3189-4

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Use of an electronic medical record reminder improves HIV screening

Research article

Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department

Research article

How to best distribute written patient education materials among patients with rheumatoid arthritis: a randomized comparison of two strategies

Research article

Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya

Research article

Effective coverage as a new approach to health system performance assessment: a scoping review

Research article

Residential location of people with chronic spinal cord injury: the importance of local health care infrastructure