Implementazione del processo decisionale condiviso (SDM) per la prevenzione CV individualizzata (SDM4IP) (SDM4IP)
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
La prevenzione primaria degli eventi cardiovascolari (CV) è spesso più intensa nei soggetti a basso rischio e viceversa (il cosiddetto "paradosso rischio-trattamento") in parte a causa dell'inconsapevolezza del rischio CV di ogni persona, delle sue preferenze per gli interventi di prevenzione, e della loro fattibilità nella vita quotidiana di ogni persona. Le linee guida di pratica clinica raccomandano che medici e pazienti lavorino insieme per arrivare a un piano di prevenzione efficace e fattibile che sia congruente con il rischio CV di ciascuna persona e le preferenze informate, un processo chiamato processo decisionale condiviso (SDM). Nonostante la disponibilità di uno strumento innovativo ed efficace che stima il rischio CV, mostra l'impatto e le caratteristiche dello stile di vita disponibile e degli interventi farmacologici preventivi, e quindi può facilitare le discussioni sul trattamento CV tra medici e pazienti, questo tipo di SDM non si verifica abitualmente nella pratica.
La sfida quindi è identificare strategie per aumentare l'adozione di questo tipo di SDM nelle pratiche cliniche del mondo reale. Questo studio di 4 anni - proposto da un team multidisciplinare con esperienza in cardiologia preventiva, SDM e scienza dell'implementazione - mira a integrare uno strumento SDM (lo strumento CV Prevention Choice) nelle pratiche di assistenza primaria di tre diversi sistemi sanitari negli Stati Uniti. e studiare sia lo strumento che le strategie su misura che ne promuovono l'adozione e l'uso di routine. Lo studio utilizzerà un metodo misto, progettazione ibrida di implementazione-efficacia (Tipo III) step-wedge clustered trial randomizzato per determinare:
- Efficacia dell'implementazione (Obiettivo 1) valutando le impostazioni (compresi il flusso di lavoro e le politiche locali) in cui viene implementato lo strumento CV Prevention Choice e il coinvolgimento degli utenti nelle strategie di implementazione; risultati dell'implementazione (ad es. portata, adozione) associati a queste strategie; e in che modo l'implementazione promuove l'adozione di routine dell'SDM e dello strumento CV Prevention Choice nelle pratiche di assistenza primaria, e
- Efficacia SDM (Obiettivo 2) stimata in base alla misura in cui i piani individuali di prevenzione CV sono fattibili e congruenti con il rischio CV stimato e le preferenze di ogni persona.
I ricercatori ipotizzano che gli sforzi per valutare le esigenze locali e utilizzarle per sviluppare approcci di implementazione su misura favoriranno una maggiore adozione di SDM nella pratica. Ipotizzano inoltre che i piani individuali di assistenza preventiva saranno congruenti con il rischio stimato quando i medici adotteranno lo strumento SDM. L'obiettivo generale è promuovere un'assistenza centrata sul paziente che riduca efficacemente il carico sostanziale delle malattie cardiovascolari tra gli americani. Entro la fine del progetto, i ricercatori si aspettano di aver (a) identificato le strategie di implementazione più efficaci per incorporare l'SDM nella pratica di routine e (b) stimato l'efficacia dell'SDM per ottenere una prevenzione CV fattibile e conforme al rischio nelle cure primarie.
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Fase
Fase
- Non applicabile
Contatti e Sedi
Luoghi di studio
-
-
Georgia
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Marietta, Georgia, Stati Uniti, 30060
- Wellstar Health System
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Minnesota
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Rochester, Minnesota, Stati Uniti, 55905
- Mayo Clinic
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North Dakota
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Grand Forks, North Dakota, Stati Uniti, 58201
- Altru Health System
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Virginia
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Arlington, Virginia, Stati Uniti, 22205
- VHC Health
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-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Descrizione
Criterio di inclusione:
- Partecipanti medici: saranno invitati a partecipare tutti i medici affiliati a una pratica di assistenza primaria partecipante e all'assistenza di pazienti adulti idonei per la prevenzione CV.
- Pazienti partecipanti: I pazienti adulti (di età compresa tra 40 e 75 anni) con o senza diabete che non hanno manifestato un evento clinico aterotrombotico e ricevono cure preventive presso una pratica di assistenza primaria partecipante saranno idonei a partecipare.
Criteri di esclusione:
- Gli individui che non parlano inglese o hanno qualsiasi tipo di deficit cognitivo che potrebbe influire sulla loro capacità di acconsentire a partecipare allo studio non saranno invitati a partecipare.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Ricerca sui servizi sanitari
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione incrociata
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Altro: 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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Lo strumento CV Prevention Choice SDM è un intervento decisionale condiviso.
È incorporato nella cartella clinica elettronica e utilizza i dati EHR per stimare e visualizzare il rischio cardiovascolare per i singoli pazienti e quindi favorire conversazioni tra medici e pazienti sulle opzioni disponibili per le cure preventive basate sul rischio e sulle preferenze individuali.
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Altro: 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.
|
Lo strumento CV Prevention Choice SDM è un intervento decisionale condiviso.
È incorporato nella cartella clinica elettronica e utilizza i dati EHR per stimare e visualizzare il rischio cardiovascolare per i singoli pazienti e quindi favorire conversazioni tra medici e pazienti sulle opzioni disponibili per le cure preventive basate sul rischio e sulle preferenze individuali.
Durante la fase di implementazione attiva, i sistemi sanitari implementeranno la facilitazione dell'implementazione su misura e altre strategie di implementazione su misura volte ad aumentare l'adozione e l'uso del processo decisionale condiviso utilizzando CV Prevention Choice.
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Altro: 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.
|
Lo strumento CV Prevention Choice SDM è un intervento decisionale condiviso.
È incorporato nella cartella clinica elettronica e utilizza i dati EHR per stimare e visualizzare il rischio cardiovascolare per i singoli pazienti e quindi favorire conversazioni tra medici e pazienti sulle opzioni disponibili per le cure preventive basate sul rischio e sulle preferenze individuali.
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Reach (RE-AIM): The Percentage of Clinicians Who Ever Used CV Prevention Choice
Lasso di tempo: 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.
|
Approximately 3.5 years
|
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Effectiveness (RE-AIM): Clinician Perceptions of CV Prevention Choice Effectiveness
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: Approximately 1 year
|
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
|
|
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
Lasso di tempo: Approximately 1 year
|
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
Lasso di tempo: 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 "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.
|
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
Lasso di tempo: 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 "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.
|
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
Lasso di tempo: 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 "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.
|
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
Lasso di tempo: 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 "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.
|
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
Lasso di tempo: 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
Lasso di tempo: 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 "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.
|
Approximately 3 years
|
|
Maintenance (RE-AIM): Clinician Self-reported Perception of Whether Staff Agree CV Prevention Choice is Worthwhile
Lasso di tempo: 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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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Effectiveness: The Predicted Marginal Probability of Statin Use is Concordant With Estimated Cardiovascular Risk
Lasso di tempo: Approximately 4 years
|
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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Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Investigatori
Investigatori
- Investigatore principale: Jennifer Ridgeway, PhD, Mayo Clinic
- Investigatore principale: Victor Montori, MD, Mayo Clinic
Pubblicazioni e link utili
Pubblicazioni generali
- 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.
Collegamenti utili
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Inizio studio (Effettivo)
Inizio studio
Completamento primario (Effettivo)
Completamento primario
Completamento dello studio (Effettivo)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- 20-002772
- R01HL151662-01 (Sovvenzione/contratto NIH degli Stati Uniti)
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