SUPPORT-AF IV

支持-AF IV

• 批准号: 10298960
• 负责人: Alok Kapoor
• 金额: $ 65.58万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10298960
• 关键词: Adherence; American; Anticoagulants; Anticoagulation; Appointment; Atrial Fibrillation; Behavior; Benefits and Risks; Cardiac; Cardiology; Caring; Cessation of life; Client satisfaction; Collaborations; Communication Tools; Data; Dissemination and Implementation; Educational Materials; Effectiveness; Electronic Health Record; Equilibrium; Event; Feedback; Fire - disasters; Florida; Future; Guidelines; Health Personnel; Health system; Hemorrhage; Individual; Informatics; Interview; Ischemic Stroke; Knowledge; Lead; Learning; Left; Link; Measurement; Measures; Methods; Minority; Minority Groups; Oral; Outcome; Patients; Pharmaceutical Preparations; Phase; Population; Population Heterogeneity; Prevalence; Prevention; Provider; Randomized; Regimen; Reporting; Research; Resources; Risk Factors; Societies; Specialist; Stroke; Stroke prevention; Test Result; Testing; Universities; Visit; base; behavioral study; care providers; clinical decision support; compliance behavior; design; digital; disability; effectiveness measure; falls; health disparity; heart rhythm; implementation efforts; implementation science; implementation tool; improved; medical specialties; novel; peer support; premature; provider intervention; safety net; satisfaction; shared decision making; stroke risk; support tools; tool

Project Summary/Abstract Six million Americans suffer from atrial fibrillation (AF), a heart rhythm abnormality that is increasing in prevalence and is also a major risk factor for stroke. AF accounts for 15% of ischemic strokes, resulting in permanent disability in 60% of cases and death in up to 20%. Oral anticoagulation (AC) is effective for AF- related stroke prevention and the vast majority of AF patients have a guideline-directed indication for oral AC. Despite this, only half of eligible AF patients receive treatment. This is particularly true among non-white AF patients, in whom AC use is lower and stroke rates are higher. The proposed project, SUPPORT-AF IV: Supporting Use of AC through Provider Prompting about Oral Anticoagulation Therapy for AF, will examine the impact of a novel AC clinical decision support tool within the electronic health record (EHR) on AC prescribing behaviors among healthcare providers from two distinct health systems who receive it. We will also examine clinician engagement through provider interviews and detailed study of behaviors using electronic health record access logs. Finally, we will refine the alert, develop a comprehensive dissemination plan, and create an implementation toolkit to widen the use of the alert at other learning health systems nationally. Specific Aims include: Aim 1: (alert enhancement) Enhance alert which will fire when eligible patients (those with AF and elevated stroke risk not on AC) visit cardiology providers and PCPs; enhancements include links to educational material, peership resources, and communication tools to use with patients not on AC. Aim 2: (adherence: AC initiation and persistence) Measure adherence including AC initiation and AC persistence (staying on AC for one year) in eligible patients (n=2632) of providers randomized to receive vs. not receive alert ; repeat measurements in the subset of minority patients (n= 402). Aim 3: (mechanism of effect) Measure association of digital crumbs with AC initiation and persistence; crumbs include alert specific actions (opening smart set and linking out to patient educational materials, peership resources, and communication tools), alert specific orders, other orders, and review of access log actions (review of various items - specialist notes, cardiac testing results, or medication list). Aim 4: (provider and patient satisfaction) Interview intervention providers (n=20) about satisfaction with alert and AC management; interview patients (n=25) satisfaction with AC management received from intervention providers. Aim 5: (dissemination and implementation) Refine alert, develop a comprehensive dissemination plan, and create an implementation toolkit that captures all lessons learned from measuring effectiveness, mechanism of effect, and provider and patient satisfaction. We are applying for the R01 (PA-18-722) - Improving Patient Adherence to Treatment and Prevention Regimens. Our research team brings together extensive expertise in AC care, informatics, implementation science and health disparities that will guide us in the execution of the proposed aims.

项目概要/摘要 六百万美国人患有心房颤动 (AF)，这是一种心律异常，在 患病率也是中风的主要危险因素。 AF 占缺血性中风的 15%，导致 60% 的病例出现永久性残疾，高达 20% 的病例死亡。口服抗凝药 (AC) 对 AF 有效 相关的中风预防，并且绝大多数 AF 患者都有指南指导的口服 AC 适应症。 尽管如此，只有一半符合资格的房颤患者接受了治疗。对于非白人 AF 来说尤其如此 空调使用率较低且中风发生率较高的患者。拟议项目 SUPPORT-AF IV： 通过提供者提示关于 AF 的口服抗凝治疗来支持 AC 的使用，将检查 电子健康记录 (EHR) 中新型 AC 临床决策支持工具对 AC 处方的影响 来自两个不同卫生系统的医疗保健提供者之间的行为。我们还将检查 通过医疗服务提供者访谈和使用电子健康对行为进行详细研究来提高临床医生的参与度 记录访问日志。最后，我们将细化警报，制定全面的传播计划，打造 一个实施工具包，用于扩大警报在全国其他学习健康系统的使用。具体的 目标包括： 目标 1：（警报增强）增强警报，当符合条件的患者（患有 AF 的患者） 和中风风险升高（非 AC））拜访心脏病专家和 PCP；增强功能包括链接 供未接受 AC 治疗的患者使用的教育材料、同伴资源和沟通工具。目标 2： （依从性：AC 启动和持续）测量依从性，包括 AC 启动和 AC 持续 （继续 AC 一年）在随机接受与不接受的提供者的合格患者 (n=2632) 中 警报 ;对少数族裔患者 (n= 402) 进行重复测量。目标3：（作用机制） 测量数字碎屑与 AC 启动和持久性的关联；碎屑包括警报特定操作 （打开智能集并链接到患者教育材料、同伴资源和沟通 工具）、提醒特定订单、其他订单以及访问日志操作的审查（各种项目的审查 - 专家 笔记、心脏测试结果或药物清单）。目标 4：（提供者和患者满意度）访谈 干预提供者 (n=20) 对警报和 AC 管理的满意度；采访患者 (n=25) 对干预提供者提供的 AC 管理的满意度。目标 5：（传播和 实施）细化警报，制定全面的传播计划，并创建实施方案 工具包涵盖了从衡量有效性、效果机制以及提供者和 患者满意度。 我们正在申请 R01 (PA-18-722) - 提高患者对治疗和预防的依从性 养生法。我们的研究团队汇集了交流护理、信息学、实施方面的丰富专业知识 科学和健康方面的差异将指导我们实现拟议的目标。