Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma

Ann F Chou, Juell B Homco, Zsolt Nagykaldi, James W Mold, F Daniel Duffy, Steven Crawford, Julie A Stoner, Ann F Chou, Juell B Homco, Zsolt Nagykaldi, James W Mold, F Daniel Duffy, Steven Crawford, Julie A Stoner

Abstract

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.

Keywords: Cardiovascular disease; Implementation and dissemination; Patient-centered outcomes; Practice facilitation; Primary care; Quality improvement.

Conflict of interest statement

Ethics approval and consent to participate

This study was reviewed and approved by the University of Oklahoma Institutional Review Board (IRB # 5251). All primary care practices that agreed to participate had undergone an informed consent process to complete enrollment. Practice facilitation and data collection began only after all required IRB paperwork has been filed.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Fig. 1
Conceptual model for implementation strategy
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Fig. 2
Primary care practices servicing adults in Oklahoma Counties
Fig. 3
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Logic model
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Fig. 4
Stepped wedge cluster randomized study design

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