Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC

Donna R Shelley, Gbenga Ogedegbe, Sheila Anane, Winfred Y Wu, Keith Goldfeld, Heather T Gold, Sue Kaplan, Carolyn Berry, Donna R Shelley, Gbenga Ogedegbe, Sheila Anane, Winfred Y Wu, Keith Goldfeld, Heather T Gold, Sue Kaplan, Carolyn Berry

Abstract

Background: HealthyHearts NYC (HHNYC) will evaluate the effectiveness of practice facilitation as a quality improvement strategy for implementing the Million Hearts' ABCS treatment guidelines for reducing cardiovascular disease (CVD) among high-risk patients who receive care in primary care practices in New York City. ABCS refers to (A) aspirin in high-risk individuals; (B) blood pressure control; (C) cholesterol management; and (S) smoking cessation. The long-term goal is to create a robust infrastructure for implementing and disseminating evidence-based practice guidelines (EBPG) in primary care practices.

Methods/design: We are using a stepped-wedge cluster randomized controlled trial design to evaluate the implementation process and the impact of practice facilitation (PF) versus usual care on ABCS outcomes in 250 small primary care practices. Randomization is at the practice site level, all of which begin as part of the control condition. The intervention consists of one year of PF that includes a combination of one-on-one onsite visits and shared learning across practice sites. PFs will focus on helping sites implement evidence-based components of patient-centered medical home (PCMH) and the chronic care model (CCM), which include decision support, provider feedback, self-management tools and resources, and linkages to community-based services.

Discussion: We hypothesize that practice facilitation will result in superior clinical outcomes compared to usual care; that the effects of practice facilitation will be mediated by greater adoption of system changes in accord with PCMH and CCM; and that there will be increased adaptive reserve and change capacity.

Trial registration: NCT02646488.

Keywords: Cardiovascular disease; Practice facilitation; Primary care.

Figures

Fig. 1
Fig. 1
Conceptual framework

References

    1. Million Hearts. . Accessed 6 April 2016.
    1. EvidenceNOW: Advancing Heart Health in Primary Care. . Accessed 6 April 2016.
    1. Hing E, Schappert SM. Generalist and specialty physicians: supply and access 2009-2010. NCHS Data Brief. 2012;105:1–8.
    1. Hing E, Uddin S. Visits to primary care delivery sites—United States, 2008. NCHS Data Brief. 2010;47:1–8.
    1. Hsiao C, Cherry DK, Beatty PC, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2007 Summary. Hyattsville: National Health Statistics Reports; 2010.
    1. Bodenheimer T, Hoangmai PH. Primary care: current problems and proposed solutions. Health Affairs. 2010; doi:10.1377/hlthaff.2010.0026
    1. Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med. 2012;10(1):63–74. doi: 10.1370/afm.1312.
    1. Knox L, Taylor EF, Geonnotti K, Machta R, Kim J, Nysenbaum J, Parchman M. Developing and running a primary care practice facilitation program: a how-to guide. Rockville: Agency for Healthcare Research and Quality; 2011.
    1. Patient Centered Medical Home Resource Center. . Accessed 6 April 2016.
    1. Chronic care model. . Accessed 6 April 2016.
    1. Liddy C, Hogg W, Russell G, Wells G, Armstrong CD, Akbari A, Dahrouge S, Taljaard M, Mayo-Bruinsma L, Singh J, Cornett A. Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care. Implement Sci. 2011;6(1):6–110. doi: 10.1186/1748-5908-6-110.
    1. Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff. 2005;24(1):138–50. doi: 10.1377/hlthaff.24.1.138.
    1. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Harvey E, Oxman A, O’Brien MA. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39(Suppl 2):2–45.
    1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362(9391):1225–30. doi: 10.1016/S0140-6736(03)14546-1.
    1. Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JT, Assendelft WJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev. 2001; doi: 10.1002/14651858.CD001481
    1. Parchman ML, Noel PH, Culler SD, Lanham HJ, Leykum LK, Romero RL, Palmer RF. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci. 2013; doi: 10.1186/1748-5908-8-93
    1. Goodwin MA, Zyzanski SJ, Zronek S, Ruhe M, Weyer SM, Konrad N, Esola D, Stange KC. A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP) Am J Prev Med. 2001;21(1):20. doi: 10.1016/S0749-3797(01)00310-5.
    1. Øvretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K, McLeod H, Molfenter T, Plsek P, Robert G, Shortell S, Wilson T. Quality collaboratives: lessons from research. Qual Saf Health Care. 2002;11(4):345–51. doi: 10.1136/qhc.11.4.345.
    1. Strickland PA, Hudson SV, Piasecki A, Hahn K, Cohen D, Orzano AJ, Parchman ML, Crabtree BF. Features of the chronic care model (CCM) associated with behavioral counseling and diabetes care in community primary care. J Am Board Fam Med. 2010;23(3):295–305. doi: 10.3122/jabfm.2010.03.090141.
    1. Ruhe MC, Weyer SM, Zronek S, Wilkinson A, Wilkinson PS, Stange KC. Facilitating practice change: lessons from the STEP-UP clinical trial. Prev Med. 2005;40(6):729–34. doi: 10.1016/j.ypmed.2004.09.015.
    1. Solberg LI. If you’ve seen one quality improvement collaborative. Ann Fam Med. 2005;3(3):198–9. doi: 10.1370/afm.304.
    1. Grimshaw J, McAuley LM, Bero LA, Grilli R, Oxman A, Ramsay C, Vale L, Zwarenstein M. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf Health Care. 2003;12(4):298–303. doi: 10.1136/qhc.12.4.298.
    1. Primary Care Information Project. . Accessed 6 April 2016.
    1. The Changing Racial and Ethnic Makeup of New York City Neighborhoods, 2011. . Accessed 6 April 2016.
    1. Karpati A, Kerker B, Mostashari F, Singh T, Hajat A, Thorpe L, Bassett M, Henning K, Frieden T. Health disparities in New York City. New York City: New York City Department of Health and Mental Hygiene; 2004.
    1. Myers C, Olson C, Kerker B, Thorpe L, Greene C, Farley T. Reducing health disparities in New York City: health disparities in life expectancy and death. New York: New York City Department of Health and Mental Hygiene; 2010.
    1. New York City Department of Health and Mental Hygiene. . Accessed 22 June 2014.
    1. Buck MD, Anane S, Taverna J, Stubbs-Dame R, Singer J. The hub population health system: distributed ad hoc queries and alerts. J Am Med Inform Assoc. 2012; Jun;19(e1):e46-50. Epub 2011 Nov 9.
    1. Damshroeder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi: 10.1186/1748-5908-4-50.
    1. Solberg LI. Improving medical practice: a conceptual framework. Ann Fam Med. 2007;5(3):251. doi: 10.1370/afm.666.
    1. Nutting PA, Crabtree BF, Stewart EE, Miller WL, Palmer RF, Stange KC, Jaén CR. Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home. Ann Fam Med. 2010; doi: 10.1370/afm.1119
    1. Solberg L, Asche SE, Margolis KL, Whitebird RR. Measuring an organization’s ability to manage change: the change process capability questionnaire and its use for improving depression care. Am J Med Qual. 2008;23(3):193–200. doi: 10.1177/1062860608314942.
    1. Knox L, Brach C. Practice facilitation handbook: training modules for new facilitators and their trainers. Rockville: Agency for Healthcare Research and Quality; 2013.
    1. Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med. 2014;12(2):166–71. doi: 10.1370/afm.1616.
    1. Practice Facilitator Certificate Program. . Accessed 6 April 2016.
    1. Parsons A, McCullough C, Wang J, Shih S. Validity of electronic health record-derived quality measurement for performance monitoring. J Am Med Inform Assoc. 2012;19(4):604–9. doi: 10.1136/amiajnl-2011-000557.
    1. Ritzwoller DP, Sukhanova A, Gaglio B, Glasgow RE. Costing behavioral interventions: a practical guide to enhance translation. Ann Behav Med. 2009;37(2):218–27. doi: 10.1007/s12160-009-9088-5.
    1. Baron RM, Kenny DA. The moderator-mediator distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82. doi: 10.1037/0022-3514.51.6.1173.
    1. Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, Gillespie C, Merritt R, Hu FB. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA. 2012;307(12):1273–83. doi: 10.1001/jama.2012.339.
    1. Centers for Disease Control and Prevention Million Hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors—United States, 2011. MMWR. 2011;60(36):1248–51.
    1. Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med. 2010;38(6):600–9. doi: 10.1016/j.amepre.2010.02.016.
    1. Lenfant C. Shattuck lecture—clinical research to clinical practice—lost in translation? N Engl J Med. 2003;349(9):868–74. doi: 10.1056/NEJMsa035507.
    1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290:199–206. doi: 10.1001/jama.290.2.199.
    1. McGlynn EA, Asch SM, Adams J, Keesey J, et al. The quality of health care delivered to adults in the United States. NEJM. 2003;348:263. doi: 10.1056/NEJMsa022615.
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001;20(6):64–78. doi: 10.1377/hlthaff.20.6.64.
    1. Berry CA, Mijanovich T, Albert S, Winther C, Paul M, Ryan MS, McCullough C, Shih S. Patient centered medical home among small urban practices serving low income and disadvantaged patients. Ann Fam Med. 2013;11(Suppl 1):82–9. doi: 10.1370/afm.1491.
    1. Kellerman WE, Herold J. Physician response to surveys: a review of the literature. Am J Prev Med. 2001;20:61–7. doi: 10.1016/S0749-3797(00)00258-0.
    1. Delivery System Reform Incentive Payment (DSRIP) Program. . Accessed 6 April 2016.
    1. State Innovation Models(SIM). . Accessed 6 April 2016.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe