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Creating change through short-term pilots and rapid cycle testing: a case of cardiovascular risk reduction

Laura Ellen Ashcraft1,2,3,4, Katy Mahraj1,4,5, Laurie A Norton1,4

  • 1University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

BMJ Open Quality
|July 15, 2026
PubMed

Insights

This study details a three-year initiative to reduce atherosclerotic cardiovascular disease (ASCVD) risk in high-risk patients. It highlights a learning health system approach to improve heart disease prevention programs and patient outcomes.

Area of Science:

  • Cardiology
  • Public Health
  • Health Systems Science

Background:

  • Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death in the USA despite available treatments.
  • Current evidence-based strategies have not optimally reduced cardiovascular risk in all patient populations.
  • High-risk patients often continue to have modifiable risk factors despite access to care.

Purpose of the Study:

  • To describe the development, evaluation, and scaling of an ASCVD Risk Reduction Initiative over three years.
  • To test innovative approaches for cardiovascular risk reduction in a large academic health system.
  • To implement a heart disease prevention program for patients with persistent high modifiable risk.

Main Methods:

  • Modeled a learning health system approach.
  • Combined randomized controlled trials with quality improvement projects.
  • Utilized iterative rapid cycle testing, data analysis, and user research.

Main Results:

  • The initiative focused on patients with high modifiable cardiovascular risk.
  • Details of the pilot study process and initial results are presented.
  • Challenges encountered during the care delivery innovation are discussed.

Conclusions:

  • The described initiative represents a novel approach to cardiovascular risk reduction.
  • The learning health system model shows promise for addressing population health challenges.
  • This case study offers insights into implementing and scaling heart disease prevention programs.

Keywords:
Collaborative, breakthrough groupsContinuous quality improvementQuality improvement

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