Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation.

Area of Science:

• Cardiovascular disease prevention
• Primary care practice transformation
• Health services research

Background:

• Practice facilitation is a strategy to improve healthcare delivery.
• Its effectiveness for multiple cardiovascular disease risk factors needs more study.
• Million Hearts ABCS (Aspirin, Blood Pressure, Cholesterol, Smoking) provides a framework for care.

Purpose of the Study:

• To determine if practice facilitation increases patient adherence to Million Hearts ABCS guidelines.
• To evaluate the impact of facilitation on aspirin use, blood pressure control, cholesterol management, and smoking interventions.

Main Methods:

• A stepped-wedge cluster randomized controlled trial involving 257 primary care practices in New York City.
• Data collected over 13 quarters (January 2015–March 2018).
• Intervention included at least 13 practice visits over one year focused on guideline implementation.

Main Results:

• The smoking (S) measure significantly improved post-intervention compared to control periods.
• Proportion of smokers receiving cessation intervention also increased significantly.
• No significant improvements were noted for the composite ABC measure.

Conclusions:

• Practice facilitation shows promise for improving specific cardiovascular risk factor management, particularly smoking cessation.
• Enhanced interventions or greater attention to policy may be necessary for broader impact.
• Further research should explore optimizing facilitation strategies for multiple risk factors.