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Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a
Ann F Chou1, Juell B Homco2, Zsolt Nagykaldi3
1College of Medicine, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 NE 10th St, Oklahoma City, OK, 73104, USA. ann-chou@ouhsc.edu.
Insights
The Healthy Hearts for Oklahoma (H2O) study established quality improvement infrastructure to enhance cardiovascular care in primary practices. This initiative aims to improve ABCS measures for better patient outcomes.
Area of Science:
- Public Health
- Healthcare Quality Improvement
- Cardiovascular Disease Prevention
Background:
- Cardiovascular disease (CVD) is a leading cause of death and high healthcare costs in the US.
- Most primary care practices (PCPs) lack adequate quality improvement (QI) support for implementing cardiovascular care measures.
- The Healthy Hearts for Oklahoma (H2O) study addresses this gap by building a QI infrastructure.
Purpose of the Study:
- To establish a sustainable QI infrastructure, the Oklahoma Primary Healthcare Improvement Collaborative (OPHIC).
- To provide QI support to PCPs for improved management of patients at risk for CVD.
- To evaluate the dissemination and implementation (D&I) of QI support and its impact on ABCS measures.
Main Methods:
- Partnering with public health agencies and communities to build OPHIC and facilitate QI.
- Implementing a bundled QI intervention in 263 small primary care practices across Oklahoma.
- Utilizing a stepped-wedge design to evaluate QI support D&I and analyze practice facilitation notes.
Main Results:
- The H2O program is projected to improve cardiovascular health for over 1.25 million Oklahomans.
- Established infrastructure will enhance access to care for medically underserved populations, including rural and tribal communities.
- Findings will inform future strategies for D&I of evidence-based practices in PCPs.
Conclusions:
- The H2O study successfully built a QI infrastructure to support primary care practices in improving cardiovascular health.
- The established collaborative and trained facilitators will continue to assist practices in delivering quality care.
- Lessons learned will guide future D&I efforts for evidence-based practices in primary care settings.
Background:
Cardiovascular disease (CVD) is the leading cause of death in the US and incurs high health care costs. While many initiatives promote the implementation of ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) measures, most primary care practices (PCPs) lack quality improvement (QI) support and resources to achieve meaningful targets. The Healthy Hearts for Oklahoma (H2O) Study proposes to build a QI infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; (2) providing QI support in PCPs to better manage patients at risk for CVD events. Parallel to infrastructure building, H2O aims to conduct a comprehensive evaluation of the QI support D&I in primary care and assess the relationship between QI support uptake and changes in ABCS measures.
Methods:
H2O has partnered with public health agencies and communities to build OPHIC and facilitate QI. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS performance. A stepped-wedge designed is used to evaluate D&I of QI support. Changes in ABCS measures will be estimated as a function of various components of the QI support and capacity and readiness of PCPs to change. Notes from academic detailing and practice facilitation sessions will be analyzed to help interpret findings on ABCS performance.
Discussion:
H2O program is designed to improve cardiovascular health and outcomes for more than 1.25 million Oklahomans. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations. Lessons learned from this project will guide future strategies for D&I of evidence-based practices in PCPs. Trained practice facilitators will continue to serve as critical resource to assists small, rural PCPs in adapting to the ever-changing health environment and continue to deliver quality care to their communities.
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