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: 10323063
• 负责人: Andrea L Cherrington
• 金额: $ 183.28万
• 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 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10323063
• 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（U.S.），过去三十年心血管疾病有了巨大的改善 然而，在心血管疾病（CVD）风险和死亡率方面，这些进展在全国各地并不一致。 心血管结局仍然存在，并且在某些情况下已经扩大，跨越种族、社会经济和 在美国东南部，中风、心肌梗塞 (MI)、糖尿病和肥胖症的发病率 根据 Millionhearts.org 的数据，阿拉巴马州的死亡率最高。 所有 50 个州的 CVD 事件（死亡、住院、急诊就诊）尽管有基于证据的指南。 心血管危险因素的筛查和治疗存在很多因素，实施效果往往不理想。 造成研究与实践之间的差距，包括教育缺陷、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。 如果向初级保健提供者和患者提供工具来 解决心血管健康问题（即评估和管理心血管风险），特别是在南方农村。 通过此申请，我们建议创建阿拉巴马州心血管合作社，以促进 协调司法努力以改善心血管风险并减少差异 合作伙伴包括 5 个。 长期致力于改善阿拉巴马州健康状况的组织 以及共同的信念，即协调一致地努力支持基于初级保健的举措，以改善 CVD 阿拉巴马州的健康状况可能会带来变革；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院 医学 (UAB)。我们将以可持续的、以 CVD 为重点的方式参与全州的初级保健实践。 “实践社区。”我们将在 60 个初级保健诊所实施心脏健康改善项目 使用三管齐下的血压 (BP) 控制率和吸烟状况筛查的次优率 方法包括实践促进和技术援助、在线和电子学习以及改进 通过数据透明度，我们将使用I型混合设计来同时测试效果。 对血压和吸烟相关结果进行干预，同时收集实施信息。 成果评估将以 Proctor 的实施成果框架为指导，我们将 通过这些，使用实施研究综合框架评估实施情况。 协调一致，我们的首要目标是推动阿拉巴马州摆脱心血管疾病的倒数四分之一 成果并减少城乡和种族差异。