SPREAD-NET: PRactices Enabling Adapting and Disseminating in the safety NET

SPREAD-NET：在安全网络中实现适应和传播的实践

• 批准号: 8611600
• 负责人: RACHEL GOLD
• 金额: $ 75.49万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8611600
• 关键词: Abbreviations; Address; Adult; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiovascular Diseases; Caring; Characteristics; Clinic; Clinical; Communities; Community Health; Community Health Centers; Cost Analysis; Decision Making; Diabetes Mellitus; Disease Outcome; Effectiveness; Electronic Health Record; Ensure; Event; Evidence based intervention; Future; Goals; Guidelines; Health Services Research; Healthcare; Intervention; Knowledge; Leadership; Learning; Link; Low-Density Lipoproteins; Maintenance; Measures; Methods; Modeling; Outcome; Patient Education; Patients; Pharmaceutical Preparations; Process; Qualitative Methods; Randomized; Readiness; Research; Research Personnel; Risk; Rosa; Safety; Site; Structure; Testing; Time; Training; Wit; Work; arm; base; blood pressure regulation; cardiovascular disorder risk; clinical care; compare effectiveness; cost; design; evidence base; evidence based guidelines; health economics; health information technology; implementation science; improved; innovation; interest; member; point of care; public health relevance; randomized trial; routine care; safety net; success; therapy design; tool

DESCRIPTION (provided by applicant): The nation's 'safety net' community health centers (CHCs) could benefit greatly from implementing interventions shown to be effective at improving health care processes and outcomes in other settings. However, a lack of knowledge about the most effective strategies for supporting implementation of evidence-based interventions in CHCs presents a major barrier to the timely dissemination of clinical innovations. Our long-term goal is to learn how best to disseminate evidence-based interventions into CHCs nationwide. Working towards that goal, we propose to compare the effectiveness of different 'support strategies' at helping diverse CHCs sustainably implement an intervention shown to reduce patients' cardiovascular disease (CVD) event risk. Kaiser Permanente developed and implemented the 'ALL Initiative' (a.k.a. 'ALL'), a clinic-level intervention designed to increase rates of adult patients with diabetes mellitus (DM) or CVD who are prescribed cardio-protective medications (statins and ACE-Inhibitors) according to evidence-based guidelines. After ALL was shown to be highly effective in Kaiser Permanente's integrated care setting, our team demonstrated the feasibility of adapting it for successful implementation in 11 CHCs - with the help of substantial implementation support. The next step in this body of research is to identify the amount and type of support needed to effectively implement and sustain this intervention in a greater number of CHCs. To that end, we will conduct a trial in which 30 CHCs are cluster-randomized to receive low, medium, or high-intensity support in implementing ALL. We will conduct this work with CHC members of OCHIN, a community health information technology network that hosts one of the nation's largest CHC electronic health record (EHR) platforms; study CHCs share a single, linked EHR. Guided by the Practice Change Model and RE-AIM framework, we will use mixed-methods to: Aim 1: Compare how effectively the low, medium, and high-intensity strategies support the CHCs' implementation of ALL, and assess change in rates of clinic patients with (i) guideline-appropriate cardioprotective prescriptions, and (ii) controlled blood pressure and low-density lipoprotein, as associated with implementation supported by the different strategies; Aim 2: Assess the strategies' effectiveness at supporting intervention sustainability over 3 years; and Aim 3: Identify clinic characteristics associated wit success at different levels of support. Our team includes CHC clinicians, and experts in dissemination and implementation (D&I), health economics, and health services research mixed-methods. Our study is designed to inform future implementation of ALL as well as other interventions known to improve outcomes among CHC patients with DM / CVD. Our results could also have high impact on D&I science, by comparing practical, generalizable methods for supporting the implementation of clinical innovations in CHCs and other ambulatory settings.

描述（由申请人提供）：国家的“安全网”社区卫生中心（CHC）可以通过实施显示有效改善其他环境中医疗保健过程和结果有效的干预措施而受益匪浅。但是，缺乏有关支持CHC中基于证据的干预措施的最有效策略的知识，这是及时传播临床创新的主要障碍。我们的长期目标是学习如何最好地将基于证据的干预措施传播到全国的CHC中。努力实现这一目标，我们建议比较不同的“支持策略”在帮助多样化的CHC可持续实施的干预措施中的有效性，以减少患者的心血管疾病（CVD）事件风险。 Kaiser Permanente开发并实施了“所有倡议”（又称“所有”），这是一种临床水平干预措施，旨在提高处方的糖尿病患者（DM）或CVD的发生率，这些患者是根据基于循证的指南。毕竟，在Kaiser Permanente的综合护理环境中表现出非常有效的效果，我们的团队证明了将其改编为在11个CHC中成功实施的可行性 - 借助实质性实施支持。这项研究的下一步是确定有效实施和维持此干预措施所需的支持的数量和类型。为此，我们将进行一项试验，在该试验中，将30个CHC随机群伴随着，以在实施所有方面获得低，中或高强度的支持。我们将与Ochin的CHC成员一起进行这项工作，Ochin是一个社区健康信息技术网络，该网络拥有全美最大的CHC电子健康记录（EHR）平台之一；研究CHC共享一个链接的EHR。在实践变更模型和重新启动框架的指导下，我们将使用混合方法来：AIM 1：比较如何有效地比较CHC对所有人的实施的有效，中等和高强度的策略，并评估（I）指南患者的临床率变化（i）指南 - 适当的心脏药物保护措施的策略，以及（II）控制的策略，以及（ii）与（ii）控制的策略相关的lip-Lipoproproper量与不同的策略相关联，与相关的不同。目标2：评估三年来支持干预可持续性的策略的有效性；目标3：确定在不同水平的支持下成功的诊所特征。我们的团队包括CHC临床医生，以及传播和实施（D＆I），健康经济学和卫生服务研究混合方法的专家。我们的研究旨在为未来对所有人的实施以及已知的其他干预措施提供信息，以改善DM / CVD患者的预后。通过比较支持CHC和其他门诊环境中临床创新的实用方法，我们的结果也可能对D＆I科学产生很大的影响。