Bridging the evidence-to-practice gap: Evaluating practice facilitation as a strategy to accelerate translation of a systems-level adherence intervention into safety net practices

弥合证据与实践之间的差距：评估实践促进作为加速将系统级依从性干预转化为安全网实践的策略

• 批准号: 10318079
• 负责人: OLUGBENGA G. OGEDEGBE
• 金额: $ 71.42万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-09 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10318079
• 关键词: Address; Adherence; Adult; Affect; Antihypertensive Agents; Attitude; Awareness; Black Populations; Blood Pressure; Caring; Clinic; Clinic Visits; Clinical; Cluster randomized trial; Consolidated Framework for Implementation Research; Data; Dimensions; Effectiveness; Electronic Health Record; Ensure; Ethnic group; Evidence based intervention; Evidence based practice; Family health status; Feedback; Health; Health Care Reform; Hypertension; Individual; Intervention; Knowledge; Latino; Latino Population; Laws; Learning; Medical; Medical Care Team; Methods; Minority Groups; Modeling; New York City; Not Hispanic or Latino; Outcome; Patient-Centered Care; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Prevalence; Preventive screening; Primary Care Physician; Primary Health Care; Proctor framework; Randomized Controlled Trials; Records; Research; Sampling; Self-Direction; Standardization; System; Testing; Time; Translating; Translation Process; Translations; Vulnerable Populations; Work; arm; base; blood pressure control; breast exam; clinical outcome measures; clinical practice; design; disparity reduction; effectiveness evaluation; efficacious intervention; evidence base; formative assessment; health care quality; health care service; health care settings; health goals; hypertension control; hypertension treatment; hypertensive; implementation facilitation; implementation fidelity; implementation outcomes; implementation strategy; improved; medication compliance; motivational enhancement therapy; patient-level barriers; personalized approach; practice factors; primary care setting; primary outcome; racial and ethnic; response; routine care; routine practice; safety net; secondary outcome; skills; statistics; systematic review; treatment as usual

Project Summary: Despite increasing awareness and treatment of hypertension (HTN) across all racial/ethnic groups, Latinos have the lowest blood pressure (BP) control rates in the US (Latino adults: 34% vs. 43% and 53% in non-Hispanic black and white adults). These statistics may be explained by the disproportionately poorer adherence to antihypertensive medications among Latinos compared to blacks and whites. Systems- level interventions conducted in primary care settings have improved medication adherence in minority populations. Our Ayudando a Latinos Hipertensos Para Mejorar Adherencia a sus Medicamentos (ALMA) trial, which informs this proposal significantly improved both BP control (51 vs. 29%, p=.04) and medication adherence (78 vs. 72%, p=.02) compared to enhanced usual care in a sample of 119 Latino patients followed in a safety-net practice. Despite their efficacy, evidence-based interventions like ALMA often take up to 17 years to be translated into clinical practice. Implementation strategies are sorely needed to accelerate the translation of evidence-based interventions into routine “real world” safety-net practices, in order to reduce disparities in BP control in vulnerable populations. Practice facilitation (PF) is one method to accelerate the implementation of evidence-based interventions into healthcare settings. Through PF, a facilitator works with healthcare teams to develop the skills to adapt and implement evidence-based system changes and promotes a tailored approach to integrating those changes into the clinic workflow. Although evidence supports the effect of PF for preventive screenings (e.g., breast examination), its impact on implementing evidence-based systems approaches to support HTN management in safety-net practices remains largely untested. This proposal provides an opportunity to fill this evidence-to-practice gap by evaluating the effectiveness of PF as a practical and replicable strategy for implementing ALMA in a network of 12 safety-net Family Health Centers (FHCs) in New York City. Using a mixed-methods design, we will conduct this study in two phases: (1) A pre- implementation phase where we will refine the PF strategy, informed by our prior work, based on the Consolidated Framework for Implementation Research to facilitate the implementation of ALMA at the FHCs. (2) An implementation phase, during which we will evaluate, in a pragmatic cluster-randomized controlled trial, the effect of the PF strategy compared to a self-directed condition (i.e., receipt of information for implementing ALMA but no facilitation) on implementation fidelity (primary outcome) of ALMA and on clinical outcomes (secondary outcome) at 12 months among a sample of 650 Latinos with uncontrolled HTN cared for at the FHCs. Implementation fidelity will be assessed using a mixed methods approach based on the five core dimensions of implementation fidelity, as defined by Proctor’s Implementation Outcomes Framework. Clinical outcome measures include BP control (defined as <140/90 mmHg) and medication adherence (assessed using the proportion of days covered via pharmacy records).

项目摘要：尽管所有种族/族裔对高血压 (HTN) 的认识和治疗不断提高 在美国，拉丁裔美国人的血压 (BP) 控制率最低（拉丁裔成年人：34% vs. 43%） 非西班牙裔黑人和白人成年人中这一比例为 53%）。 与黑人和白人相比，拉丁美洲人对抗高血压药物的依从性较差。 在初级保健机构中进行的水平干预措施提高了少数群体的药物依从性 我们的 Ayudando a Latinos Hipertensos Para Mejorar Adherencia a sus Medicamentos (ALMA) 试验， 这表明该提案显着改善了血压控制（51% vs. 29%，p=.04）和药物治疗 与 119 名拉丁裔患者样本中的强化常规护理相比，依从性（78% vs. 72%，p=.02） 尽管 ALMA 等基于证据的干预措施很有效，但通常需要 17 个小时。 迫切需要将实施策略转化为临床实践，以加速这一进程。 将循证干预措施转化为常规的“现实世界”安全网实践，以减少 弱势群体血压控制的差异是加速实践促进（PF）的一种方法。 通过 PF，协调员与医疗机构合作实施基于证据的干预措施。 医疗保健团队培养适应和实施循证系统变革的技能，并促进 尽管有证据支持这种效果，但还是有一种量身定制的方法将这些变化整合到临床工作流程中。 预防性筛查（例如乳房检查）的 PF 及其对实施基于证据的影响 在安全网实践中支持 HTN 管理的系统方法在很大程度上尚未经过测试。 该提案提供了一个机会，通过评估 PF 作为一种方法的有效性来填补这一证据与实践之间的差距。 在 12 个安全网家庭健康中心网络中实施 ALMA 的实用且可复制的策略 （FHC）采用混合方法设计，我们将分两个阶段进行这项研究：（1）预- 实施阶段，我们将根据我们之前的工作，根据 实施研究综合框架，以促进 ALMA 在 FHC 的实施。 (2) 实施阶段，在此期间我们将在务实的整群随机对照试验中进行评估， PF 策略与自我导向条件（即收到实施信息的信息）相比的效果 ALMA 但无促进）关于 ALMA 的实施保真度（主要结果）和临床结果 （次要结果）在 12 个月时，对 650 名患有不受控制的高血压的拉丁裔样本进行了研究，并在该机构接受治疗。 FHC 将使用基于五个核心的混合方法来评估实施保真度。 实施保真度的维度，由 Proctor 的实施成果临床框架定义。 结果测量包括血压控制（定义为<140/90 mmHg）和药物依从性（评估 使用药房记录涵盖的天数比例）。