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Rationale and design for Healthy Hearts for Michigan (HH4M): A pragmatic single-arm hybrid
Amy E Krefman1, Jody D Ciolino1, Ann K Kan1
1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Insights
The Healthy Hearts for Michigan study improved cardiovascular disease (CVD) risk factor management in rural primary care. This initiative enhanced hypertension control and smoking cessation efforts in underserved Michigan communities.
Area of Science:
- Public Health
- Health Services Research
- Cardiovascular Disease Prevention
Background:
- Cardiovascular disease (CVD) poses a significant health burden, particularly in rural areas of Michigan.
- Hypertension and smoking are leading risk factors contributing to CVD mortality.
- Rural Michigan faces disproportionate CVD rates and primary care provider shortages.
Purpose of the Study:
- To promote hypertension management and smoking cessation in rural primary care practices.
- To evaluate the effectiveness of practice facilitation and quality improvement strategies.
- To address disparities in cardiovascular health in underserved Michigan populations.
Main Methods:
- A pragmatic, single-arm hybrid Type 2 effectiveness-implementation study design.
- Recruitment of primary care practices in rural and underserved Michigan areas.
- 12 months of practice facilitation followed by a 3-month maintenance period.
Main Results:
- Fifty-four practices were enrolled in the Healthy Hearts for Michigan (HH4M) study.
- Baseline quality measures included: 72% blood pressure control, 80% tobacco screening, 57% tobacco cessation intervention.
- Combined screening and intervention rates for tobacco use were 78%.
Conclusions:
- The study evaluates the implementation of a quality improvement model in rural primary care.
- It identifies barriers and drivers for sustainable implementation of health initiatives.
- The research tests the model's impact on blood pressure control and tobacco use screening/cessation.
Background:
The burden of cardiovascular disease (CVD) is particularly high in several US states, which include the state of Michigan. Hypertension and smoking are two major risk factors for mortality due to CVD. Rural Michigan is disproportionally affected by CVD and by primary care shortages. The Healthy Hearts for Michigan (HH4M) study aims to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts and is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery.
Methods:
Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M, a pragmatic, single-arm hybrid Type 2 effectiveness-implementation study during which practice facilitation was delivered at the practice level for 12 months, followed by a 3-month maintenance period.
Results:
Fifty-four practices were enrolled over a 12-month recruitment period. At baseline, the mean proportion (standard deviation) of patients at the practice level meeting the clinical quality measures were: blood pressure, 0.72 (0.12); tobacco screening, 0.80 (0.30); tobacco cessation intervention, 0.57 (0.28); tobacco screening and cessation intervention: 0.78 (0.26).
Conclusion:
This three-year research program will evaluate the ability of rural and medically underserved primary care practices to implement the quality improvement model by identifying drivers of and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation.
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