Implementación de la toma de decisiones compartida (SDM) para la prevención de CV individualizada (SDM4IP) (SDM4IP)
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Descripción detallada
La prevención primaria de eventos cardiovasculares (CV) suele ser más intensa en individuos de menor riesgo y viceversa (la llamada "paradoja riesgo-tratamiento") en parte debido al desconocimiento del riesgo CV de cada persona, de sus preferencias por las intervenciones de prevención, y de su viabilidad en la vida cotidiana de cada persona. Las guías de práctica clínica recomiendan que los médicos y los pacientes trabajen juntos para llegar a un plan de prevención efectivo y factible que sea congruente con el riesgo CV de cada persona y sus preferencias informadas, un proceso llamado toma de decisiones compartida (SDM). A pesar de la disponibilidad de una herramienta innovadora y efectiva que estima el riesgo CV, muestra el impacto y las características de las intervenciones preventivas farmacológicas y de estilo de vida disponibles y, por lo tanto, puede facilitar las discusiones sobre el tratamiento CV entre médicos y pacientes, este tipo de SDM no ocurre de forma rutinaria en la práctica.
Por lo tanto, el desafío es identificar estrategias para aumentar la adopción de este tipo de SDM en las prácticas clínicas del mundo real. Este estudio de 4 años, propuesto por un equipo multidisciplinario con experiencia en cardiología preventiva, SDM y ciencia de la implementación, tiene como objetivo integrar una herramienta SDM (la herramienta CV Prevention Choice) en las prácticas de atención primaria de tres sistemas de atención médica diversos en los EE. UU. y estudiar tanto la herramienta como las estrategias a medida que fomentan su adopción y uso rutinario. El estudio utilizará un diseño de ensayo aleatorizado agrupado escalonado de implementación-eficacia híbrida (Tipo III) de método mixto para determinar:
- Eficacia de la implementación (Objetivo 1) mediante la evaluación de los entornos (incluidos el flujo de trabajo y las políticas locales) en los que se implementa la herramienta CV Prevention Choice y la participación de los usuarios en las estrategias de implementación; resultados de implementación (p. ej., alcance, adopción) asociados con estas estrategias; y cómo la implementación fomenta la adopción rutinaria de SDM y la herramienta CV Prevention Choice en las prácticas de atención primaria, y
- Eficacia del SDM (Objetivo 2) estimada por la medida en que los planes individuales de prevención CV son factibles y congruentes con el riesgo CV estimado y las preferencias de cada persona.
Los investigadores plantean la hipótesis de que los esfuerzos para evaluar las necesidades locales y utilizarlas para desarrollar enfoques de implementación personalizados fomentarán una mayor adopción de SDM en la práctica. Además, plantean la hipótesis de que los planes de atención preventiva individuales serán congruentes con el riesgo estimado cuando los médicos adopten la herramienta SDM. El objetivo general es promover la atención centrada en el paciente que reduzca de manera efectiva la carga sustancial de enfermedades cardiovasculares entre los estadounidenses. Para el final del proyecto, los investigadores esperan haber (a) identificado las estrategias de implementación más efectivas para integrar SDM en la práctica de rutina y (b) estimado la efectividad de SDM para lograr una prevención CV factible y concordante con el riesgo en la atención primaria.
Tipo de estudio
Tipo de estudio
Inscripción (Actual)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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Georgia
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Marietta, Georgia, Estados Unidos, 30060
- Wellstar Health System
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Minnesota
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Rochester, Minnesota, Estados Unidos, 55905
- Mayo Clinic
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North Dakota
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Grand Forks, North Dakota, Estados Unidos, 58201
- Altru Health System
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Virginia
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Arlington, Virginia, Estados Unidos, 22205
- VHC Health
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-
Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Descripción
Criterios de inclusión:
- Participantes médicos: Se invitará a participar a todos los médicos que estén afiliados a una práctica de atención primaria participante y que atiendan a pacientes adultos elegibles para la prevención CV.
- Pacientes participantes: Los pacientes adultos (de 40 a 75 años de edad) con o sin diabetes que no hayan experimentado un evento clínico aterotrombótico y reciban atención preventiva en un consultorio de atención primaria participante serán elegibles para participar.
Criterio de exclusión:
- No se invitará a participar a las personas que no hablen inglés o que tengan algún tipo de déficit cognitivo que afecte su capacidad para dar su consentimiento para participar en el estudio.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Investigación de servicios de salud
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación cruzada
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
|---|---|
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Otro: 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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La herramienta CV Prevention Choice SDM es una intervención de toma de decisiones compartida.
Está integrado en el registro de salud electrónico y utiliza datos de EHR para estimar y mostrar el riesgo cardiovascular para pacientes individuales y luego fomentar conversaciones entre médicos y pacientes sobre las opciones disponibles para la atención preventiva según el riesgo y las preferencias individuales.
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Otro: 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.
|
La herramienta CV Prevention Choice SDM es una intervención de toma de decisiones compartida.
Está integrado en el registro de salud electrónico y utiliza datos de EHR para estimar y mostrar el riesgo cardiovascular para pacientes individuales y luego fomentar conversaciones entre médicos y pacientes sobre las opciones disponibles para la atención preventiva según el riesgo y las preferencias individuales.
Durante la etapa de implementación activa, los sistemas de salud implementarán la facilitación de implementación personalizada y otras estrategias de implementación personalizadas destinadas a aumentar la adopción y el uso de la toma de decisiones compartida utilizando CV Prevention Choice.
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Otro: 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.
|
La herramienta CV Prevention Choice SDM es una intervención de toma de decisiones compartida.
Está integrado en el registro de salud electrónico y utiliza datos de EHR para estimar y mostrar el riesgo cardiovascular para pacientes individuales y luego fomentar conversaciones entre médicos y pacientes sobre las opciones disponibles para la atención preventiva según el riesgo y las preferencias individuales.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Reach (RE-AIM): The Percentage of Clinicians Who Ever Used CV Prevention Choice
Periodo de tiempo: 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
Periodo de tiempo: Approximately 3.5 years
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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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: Approximately 3 years
|
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
Periodo de tiempo: 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
Periodo de tiempo: Approximately 3 years
|
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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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Effectiveness: The Predicted Marginal Probability of Statin Use is Concordant With Estimated Cardiovascular Risk
Periodo de tiempo: 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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Colaboradores e Investigadores
Patrocinador
Patrocinador
Colaboradores
Colaboradores
Investigadores
Investigadores
- Investigador principal: Jennifer Ridgeway, PhD, Mayo Clinic
- Investigador principal: Victor Montori, MD, Mayo Clinic
Publicaciones y enlaces útiles
Publicaciones Generales
- 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.
Enlaces Útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Inicio del estudio
Finalización primaria (Actual)
Finalización primaria
Finalización del estudio (Actual)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Otros números de identificación del estudio
Otros números de identificación del estudio
- 20-002772
- R01HL151662-01 (Subvención/contrato del NIH de EE. UU.)
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
producto fabricado y exportado desde los EE. UU.
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