The Alabama Cardiovascular Cooperative: Supporting Cardiovascular Risk Reduction in Primary Care

阿拉巴马州心血管合作社：支持初级保健中降低心血管风险

• 批准号: 10542719
• 负责人: Andrea L Cherrington
• 金额: $ 132万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10542719
• 关键词: Alabama; Cardiovascular; Cooperative; Supporting; Risk

In the United States (U.S.), the last three decades have seen vast improvements in cardiovascular disease (CVD) risk and mortality, however, these gains are not consistent across all regions of the country. Inequities in cardiovascular outcomes remain, and in some cases have widened, across racial, socio-economic, and geographic lines. In the Southeastern U.S., rates of stroke, myocardial infarction (MI), diabetes and obesity are among the highest in the nation. According to data from millionhearts.org, Alabama has the highest rate of CVD events (death, hospitalizations, ED visits) among all 50 states. Although evidence-based guidelines for screening and treatment of cardiovascular risk factors exist, implementation is often suboptimal. Many factors contribute to the research-to-practice gap, including educational deficiencies, time constraints for providers, lack of feedback mechanisms and decision support tools, as well as cultural factors and organizational climate. There is potential for real impact in CVD health if primary care providers and patients are provided with tools to address cardiovascular health (i.e., assess and manage cardiovascular risks), particularly in the rural south. With this application, we propose the creation of the Alabama Cardiovascular Cooperative to promote coordination of statewide efforts to improve cardiovascular risk and reduce disparities. Partners include 5 organizations with long-standing commitments to improving health outcomes in Alabama, broad statewide reach, and a shared belief that a coordinated effort to support primary care-based initiatives to improve CVD health in Alabama could prove transformative; these entities include the Alabama Department of Public Health (ADPH), the Alabama Quality Assurance Foundation (AQAF), the Alabama Primary Health Care Association (APHCA), Auburn University School of Pharmacy, and the University of Alabama at Birmingham School of Medicine (UAB). We will engage primary care practices from across the state in a sustainable, CVD-focused “community of practice.” We will implement a Heart Health Improvement project in 60 primary care clinics with suboptimal rates of blood pressure (BP) control and screening for smoking status using a 3-prongued approach comprising Practice Facilitation & Technical Assistance, Online & eLearning, and Improvement through Data Transparency. We will use a Type I hybrid design, to simultaneously test the effects of the intervention on BP and smoking-related outcomes while also gathering information on implementation. The outcomes evaluation will be guided by the Proctor’s Framework for Implementation Outcomes, and we will assess implementation using the Consolidated Framework for Implementation Research. Through these coordinated efforts, our overarching goal is to propel Alabama out of the bottom quartile for cardiovascular outcomes and reduce rural/urban and racial disparities.

在美国（美国），最近三十年的心血管疾病有了很大改善 （CVD）风险和死亡率，但是，在该国所有地区，这些收益并不一致。不平等 仍然存在心血管结局，在某些情况下，跨越种族，社会经济和 地理线条。在美国东南部，中风，心肌梗塞（MI），糖尿病和肥胖症的速度为 在全国最高的地方。根据百万hearts.org的数据，阿拉巴马州的比率最高 在所有50个州中，CVD事件（死亡，住院，急诊室访问）。虽然是基于证据的指南 存在心血管危险因素的筛查和治疗，实施通常是次优的。许多因素 为实践差距做出贡献，包括教育缺陷，给提供者的时间限制， 缺乏反馈机制和决策支持工具以及文化因素和组织氛围。 如果为初级保健提供者和患者提供工具，则可能会对CVD健康产生真正的影响 解决心血管健康（即评估和管理心血管风险），尤其是在南方农村。 通过此应用程序，我们建议创建阿拉巴马州心血管合作社以促进 全州努力改善心血管风险并减少分布的协调。合作伙伴包括5 长期以来一直致力于改善阿拉巴马州健康状况的组织，全州广泛 覆盖范围，并共同相信，协调的努力支持基于初级保健的计划以改善CVD 阿拉巴马州的健康可能证明是变革性的。这些实体包括阿拉巴马州公共卫生部 （ADPH），阿拉巴马州质量保证基金会（AQAF），阿拉巴马州初级卫生保健协会 （APHCA），奥本大学药学院和阿拉巴马大学伯明翰学校 医学（UAB）。我们将以可持续的，以CVD为中心 “实践社区。”我们将在60个初级保健诊所中实施心脏健康改善项目 血压（BP）控制率（BP）的次优率和筛查吸烟状态的筛查 完成实践促进和技术援助，在线和电子学习以及改进的方法 通过数据透明度。我们将使用I型混合设计，简单地测试 干预BP和与吸烟有关的结果，同时还收集有关实施的信息。这 成果评估将以Proctor的实施成果为指导，我们将 使用合并框架进行实施研究评估实施。通过这些 我们的总体目标是协调的努力，是将阿拉巴马州推向底部四分位数 结果并减少粗糙/城市和种族分布。