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A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.

Abstract：

OBJECTIVE:To assess the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. STUDY SETTING:A total of 219 small primary care practices (≤10 clinicians per site) across North Carolina with primary data collection from electronic health records (EHRs) from the fourth quarter of 2015 through the second quarter of 2018. STUDY DESIGN:We performed a stepped-wedge, stratified, cluster randomized trial of a one-year intervention consisting of practice facilitation utilizing quality improvement techniques coupled with a cardiovascular dashboard that included lists of risk-stratified adults, aged 40-79 years and their unmet treatment opportunities. The primary outcome was change in 10-Year ASCVD Risk score among all patients with a baseline score ≥10 percent from baseline to 3 months postintervention. DATA COLLECTION/ EXTRACTION METHODS:Data extracts were securely transferred from practices on a nightly basis from their EHR to the research team registry. PRINCIPLE FINDINGS:ASCVD risk scores were assessed on 437 556 patients and 146 826 had a calculated 10-year risk ≥10 percent. The mean baseline risk was 23.4 percent (SD ± 12.6 percent). Postintervention, the absolute risk reduction was 6.3 percent (95% CI 6.3, 6.4). Models considering calendar time and stepped-wedge controls revealed most of the improvement (4.0 of 6.3 percent) was attributable to the intervention and not secular trends. In multivariate analysis, male gender, age >65 years, low-income (<$40 000), and Black race (P < .001 for all variables) were each associated with greater risk reductions. CONCLUSION:A risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year ASCVD risk for patients at high risk. Similar approaches could lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices. Registration: ClinicalTrials.Gov 15-0479.

journal_name

Health Serv Res

journal_title

Health services research

authors

Cykert S,Keyserling TC,Pignone M,DeWalt D,Weiner BJ,Trogdon JG,Wroth T,Halladay J,Mackey M,Fine J,In Kim J,Cene C

doi

10.1111/1475-6773.13571

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

944-953

issue

eissn

0017-9124

issn

1475-6773

journal_volume

pub_type

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A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.