Implementering af fælles beslutningstagning (SDM) for individualiseret CV-forebyggelse (SDM4IP) (SDM4IP)
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Den primære forebyggelse af kardiovaskulære (CV) hændelser er ofte mere intens hos individer med lavere risiko og omvendt (det såkaldte "risikobehandlingsparadoks"), delvis på grund af ubevidsthed om hver persons CV-risiko, om deres præferencer for forebyggende interventioner, og deres gennemførlighed i hver persons daglige liv. Retningslinjer for klinisk praksis anbefaler, at klinikere og patienter arbejder sammen for at nå frem til en effektiv og gennemførlig forebyggelsesplan, der er i overensstemmelse med hver persons CV-risiko og informerede præferencer, en proces kaldet delt beslutningstagning (SDM). På trods af tilgængeligheden af et innovativt og effektivt værktøj, der estimerer CV-risiko, viser virkningen og funktionerne af tilgængelige livsstils- og farmakologiske forebyggende interventioner og dermed kan lette CV-behandlingsdiskussioner mellem klinikere og patienter, sker denne type SDM ikke rutinemæssigt i praksis.
Udfordringen er derfor at identificere strategier til at øge adoptionen af denne type SDM i klinisk praksis i den virkelige verden. Denne 4-årige undersøgelse - foreslået af et tværfagligt team med ekspertise inden for forebyggende kardiologi, SDM og implementeringsvidenskab - har til formål at integrere et SDM-værktøj (CV Prevention Choice-værktøjet) i primærplejepraksis i tre forskellige sundhedssystemer i USA. og studere både værktøjet og skræddersyede strategier, der fremmer dets vedtagelse og rutinemæssige brug. Undersøgelsen vil bruge en blandet metode, hybrid implementeringseffektivitet (Type III) trin-kile klynget randomiseret forsøgsdesign til at bestemme:
- Implementeringseffektivitet (Mål 1) ved at evaluere de indstillinger (herunder lokale arbejdsgange og politikker), hvori CV Prevention Choice-værktøjet er implementeret, og brugernes engagement i implementeringsstrategier; implementeringsresultater (f.eks. rækkevidde, vedtagelse) forbundet med disse strategier; og hvordan implementering fremmer rutinemæssig vedtagelse af SDM og CV Prevention Choice-værktøjet i primærplejepraksis, og
- SDM-effektivitet (Mål 2) estimeret ud fra, i hvilket omfang individuelle CV-forebyggelsesplaner er gennemførlige og i overensstemmelse med hver persons estimerede CV-risiko og præferencer.
Efterforskerne antager, at bestræbelser på at vurdere lokale behov og bruge dem til at udvikle skræddersyede implementeringstilgange vil fremme en større anvendelse af SDM i praksis. De antager yderligere, at individuelle forebyggende plejeplaner vil være i overensstemmelse med estimeret risiko, når klinikere anvender SDM-værktøjet. Det overordnede mål er at fremme patientcentreret pleje, der effektivt reducerer den betydelige byrde af CV-sygdom blandt amerikanere. Ved projektets afslutning forventer efterforskerne at have (a) identificeret de mest effektive implementeringsstrategier til at indlejre SDM i rutinepraksis og (b) estimeret effektiviteten af SDM til at opnå gennemførlig og risikooverensstemmende CV-forebyggelse i primærpleje.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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Georgia
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Marietta, Georgia, Forenede Stater, 30060
- Wellstar Health System
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Minnesota
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Rochester, Minnesota, Forenede Stater, 55905
- Mayo Clinic
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North Dakota
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Grand Forks, North Dakota, Forenede Stater, 58201
- Altru Health System
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Virginia
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Arlington, Virginia, Forenede Stater, 22205
- VHC Health
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
- Klinikerdeltagere: Alle klinikere, der er tilknyttet en deltagende primærplejepraksis og pleje af voksne patienter, der er berettiget til CV-forebyggelse, vil blive inviteret til at deltage.
- Patientdeltagere: Voksne patienter (i alderen 40-75 år) med eller uden diabetes, som ikke har oplevet en aterotrombotisk klinisk hændelse og modtager forebyggende behandling i en deltagende primærplejepraksis, vil være berettiget til at deltage.
Ekskluderingskriterier:
- Personer, der ikke taler engelsk eller har nogen form for kognitivt underskud, der kan påvirke deres evne til at give samtykke til at deltage i undersøgelsen, vil ikke blive inviteret til at deltage.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Sundhedstjenesteforskning
- Tildeling: Randomiseret
- Interventionel model: Crossover opgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Andet: Sequence 1
Sequence 1 began usual care (Step 1) on 9/24/2021, entered the active implementation period (Step 2) on 3/24/2022, and entered the maintenance period (Step 3) on 4/1/2024.
In usual care, clinicans had access to CV Prevention Choice in their electronic health record but there were no other active implementation strategies deployed (passive implementation).
The active implementation period included deployment of tailored implementaiton strategies.
In the maintenance period, active implementation support ended but clinicians still had access to CV Prevention Choice in the EHR
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CV Prevention Choice SDM-værktøjet er en fælles beslutningstagning.
Den er indlejret i den elektroniske patientjournal og bruger EPJ-data til at estimere og vise kardiovaskulær risiko for individuelle patienter og derefter fremme samtaler mellem klinikere og patienter om tilgængelige muligheder for forebyggende behandling baseret på individuelle risici og præferencer.
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Andet: Sequence 2
Sequence 2 began usual care (Step 1) on 4/13/2022, entered the active implementation period (Step 2) on 10/14/2022, and entered the maintenance period (Step 3) on 4/1/2024.
In usual care, clinicans had access to CV Prevention Choice in their electronic health record but there were no other active implementation strategies deployed (passive implementation).
The active implementation period included deployment of tailored implementaiton strategies.
In the maintenance period, active implementation support ended but clinicians still had access to CV Prevention Choice in the EHR.
|
CV Prevention Choice SDM-værktøjet er en fælles beslutningstagning.
Den er indlejret i den elektroniske patientjournal og bruger EPJ-data til at estimere og vise kardiovaskulær risiko for individuelle patienter og derefter fremme samtaler mellem klinikere og patienter om tilgængelige muligheder for forebyggende behandling baseret på individuelle risici og præferencer.
Under den aktive implementeringsfase vil sundhedssystemerne implementere skræddersyet implementeringsfacilitering og andre skræddersyede implementeringsstrategier, der sigter mod at øge vedtagelsen og brugen af fælles beslutningstagning ved hjælp af CV Prevention Choice.
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Andet: Sequence 3
Sequence 3 began usual care (Step 1) on 6/13/2022, entered the active implementation period (Step 2) on 12/13/2022, and entered the maintenance period (Step 3) on 4/1/2024.
In usual care, clinicans had access to CV Prevention Choice in their electronic health record but there were no other active implementation strategies deployed (passive implementation).
The active implementation period included deployment of tailored implementaiton strategies.
In the maintenance period, active implementation support ended but clinicians still had access to CV Prevention Choice in the EHR.
|
CV Prevention Choice SDM-værktøjet er en fælles beslutningstagning.
Den er indlejret i den elektroniske patientjournal og bruger EPJ-data til at estimere og vise kardiovaskulær risiko for individuelle patienter og derefter fremme samtaler mellem klinikere og patienter om tilgængelige muligheder for forebyggende behandling baseret på individuelle risici og præferencer.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Reach (RE-AIM): The Percentage of Clinicians Who Ever Used CV Prevention Choice
Tidsramme: Approximately 3.5 years
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Percentage of clinicians who used CV Prevention Choice, among all eligible clinicians in participating settings.
Clinicians were eligible if they had at least one encounter during the period evaluated.
Utilization was recorded in the electronic health record.
Higher percentages indicate greater intervention reach.
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Approximately 3.5 years
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Effectiveness (RE-AIM): Clinician Perceptions of CV Prevention Choice Effectiveness
Tidsramme: Approximately 3.5 years
|
Perceptions of CV Prevention Choice effectiveness, including whether it helps support shared decision making conversations, as assessed through interviews with eligible clinicians.
Participant counts reflect the number of interview participants in the arm/group who indicated CV Prevention Choice supports shared decision making, does not support shared decision making, or were unsure whether it supported shared decision making.
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Approximately 3.5 years
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Adoption (RE-AIM): The Percentage of Clinicians Who Adopted CV Prevention Choice in Routine Care
Tidsramme: Approximately 3.5 years
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Percentage of eligible clinicians that used CV Prevention Choice in encounters identified in the electronic health record as a visit for preventive care (visit reason listed as annual exam or annual wellness visit), among all eligible preventive care encounters.
Utilization was recorded in the electronic health record.
Higher percentages indicate greater adoption.
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Approximately 3.5 years
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Adoption (RE-AIM): Clinician Perceptions of CV Prevention Choice Adoption
Tidsramme: Approximately 3.5 years
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Perceptions of CV Prevention Choice adoption, including reasons for adopting it or failing to adopt it in routine care, as assessed through interviews with eligible clinicians.
Participant counts reflect the number of interview participants in the arm/group who gave reasons for adopting or not adopting CV Prevention Choice.
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Approximately 3.5 years
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Implementation (RE-AIM): Observer Scoring of Clinician Fidelity to Shared Decision Making Behaviors in Audio-video Recorded Encounters
Tidsramme: Approximately 1 year
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A sample of clinical encounters were audio-video recorded, reviewed by trained study staff, and scored using a fidelity checklist with 10 items indicating shared decision making behaviors.
Each item was scored on a on a scale from -1=Behavior was undermined by comment or action to 4=The behavior is exhibited to a very high standard.
An overall average score ranging from -1 to 4 was created by averaging the 10 item scores.
A higher mean score indicates greater fidelity to the core components of shared decision making.
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Approximately 1 year
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Implementation (RE-AIM): Average Patient-reported Rating of the Quality of Shared Decision Making After a Clinical Encounter
Tidsramme: Approximately 1 year
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The quality of shared decision making was assessed using the Shared Decision Making Questionnaire (SDM-Q-9), which is a patient self-report measure designed to measure the extent and quality of shared decision making in a clinical encounter from the patient perspective.
The nine items are scored on a 6-point Likert scale from 1 (Completely Disagree) to 6 (Completely Agree).
Scores are summed and transformed to a 0-100 scale, with higher scores indicating greater perceived involvement in decision-making.
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Approximately 1 year
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Implementation (RE-AIM): Average Patient-reported Quality of Care After a Clinical Encounter
Tidsramme: Approximately 1 year
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The quality of care was assessed using the 10-item Consultation and Relational Empathy (CARE) Measure, which is a patient-reported measure of the experience of care in a clinical encounter.
Higher scores are indicative of higher patient reported relational empathy in the consultation.
Items are scored from 1 (Poor) to 5 (Excellent) and summed for a range of scores from 10 to 50.
Higher scores indicate more positive assessment of care processes.
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Approximately 1 year
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Maintenance (RE-AIM): The Percentage of Clinicians Using CV Prevention Choice at the End of the Maintenance Period Compared to the Beginning of the Period
Tidsramme: Approximately 1 year
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The percentage of clinicians using CV Prevention Choice, as indicated in the electronic health record, at the transition to the maintenance period was compared to the percentage in the last two months of the maintenance phase.
Equivalent or higher percentage use at the end of the maintenance stage indicates maintenance of the tool as part of routine practice.
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Approximately 1 year
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Maintenance (RE-AIM): Clinician Self-reported Perception of How CV Prevention Choice Differs From Usual Ways of Working
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "I can see how it differs from usual ways of working" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Maintenance (RE-AIM): Clinician Self-reported Perception of Whether CV Prevention Choice Has Potential Value for Their Work
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "I can see the potential value of it for my own work" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Maintenance (RE-AIM): Clinician Self-reported Perception of Whether There Are Key People to Drive CV Prevention Choice Forward and Get Others Involved
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "There are key people who drive it forward and get others involved" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Maintenance (RE-AIM): Clinician Self-reported Perception of Whether CV Prevention Choice Can be Easily Integrated Into Existing Work
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "I can easily integrate it into my existing work" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Maintenance (RE-AIM): Clinician Self-reported Perception of Whether Sufficient Training Was Provided to Implement CV Prevention Choice
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "Sufficient training is provided to enable staff to implement it" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Maintenance (RE-AIM): Clinician Self-reported Perception of Management Support for CV Prevention Choice
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "Management adequately supports it" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Maintenance (RE-AIM): Clinician Self-reported Perception of Whether Staff Agree CV Prevention Choice is Worthwhile
Tidsramme: Approximately 3 years
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Seven items from the 23-item Normalization Measure Development Questionnaire (NoMAD) were administered to clinicians to assess the extent to which CV Prevention Choice had become a routine part of their practice (i.e., normalized in practice).
The item "The staff agree that it is worthwhile" was scored on a Likert scale from 1=Strongly disagree to 5=Strongly agree.
Higher levels of agreement indicate higher levels of normalization of CV Prevention Choice into routine care.
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Approximately 3 years
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Effectiveness: The Predicted Marginal Probability of Statin Use is Concordant With Estimated Cardiovascular Risk
Tidsramme: Approximately 4 years
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Patient risk-concordance was assessed using all of the patient's encounter level data.
Statin prescription status was captured in the EHR up to 30 days after the encounter (i.e., the patient-clinician clinical visit) and their estimated 10-year risk of developing a first atherosclerotic cardiovascular disease (ASCVD) event, calculated using the Pooled Cohort Equation and data from the EHR including: age, race, total cholesterol, HDL cholesterol, systolic blood pressure, smoking status, diabetes status, and whether the individual is receiving treatment for high blood pressure (if systolic blood pressure is greater than 120 mmHg).
Risk concordance was defined as having a statin prescription in groups where ASCVD risk was > or equal to 7.5% and not having a statin prescription if it was < 7.5%.
The least square means, using the patient's encounter level data, provides a marginal probability of the proportion of patients that would have a statin prescription within the risk*arm/group.
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Approximately 4 years
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Jennifer Ridgeway, PhD, Mayo Clinic
- Ledende efterforsker: Victor Montori, MD, Mayo Clinic
Publikationer og nyttige links
Generelle publikationer
- Ridgeway JL, Branda ME, Gravholt D, Brito JP, Hargraves IG, Hartasanchez SA, Leppin AL, Gomez YL, Mann DM, Nautiyal V, Thomas RJ, Behnken EM, Torres Roldan VD, Shah ND, Khurana CS, Montori VM. Increasing risk-concordant cardiovascular care in diverse health systems: a mixed methods pragmatic stepped wedge cluster randomized implementation trial of shared decision making (SDM4IP). Implement Sci Commun. 2021 Apr 21;2(1):43. doi: 10.1186/s43058-021-00145-6.
- Ridgeway JL, Branda ME, Bagewadi S, Montori V, Jackson H, Nautiyal V, Dagoberg A, Gomez YL, Gharai H, Khurana CS, Louks K, Gravholt DL, Montori VM. Champions and early adopters in an implementation-effectiveness study of shared decision making: implications for interpersonal strategies. Implement Sci Commun. 2026 May 30. doi: 10.1186/s43058-026-00977-0. Online ahead of print.
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 20-002772
- R01HL151662-01 (U.S. NIH-bevilling/kontrakt)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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