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, Olugbenga Ogedegbe, Sheila Anane, Winfred Y. Wu, Keith Goldfeld, Heather T. Gold, Sue Kaplan, Carolyn Berry

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number88
JournalImplementation Science
Volume11
Issue number1
DOIs
StatePublished - 2016

Fingerprint

Primary Health Care
Patient-Centered Care
Cardiovascular Diseases
Guidelines
Home Care Services
Social Welfare
Evidence-Based Practice
Smoking Cessation
Self Care
Random Allocation
Quality Improvement
Practice Guidelines
Aspirin
Randomized Controlled Trials
Cholesterol
Learning
Blood Pressure
Therapeutics

Keywords

  • Cardiovascular disease
  • Practice facilitation
  • Primary care

ASJC Scopus subject areas

  • Medicine(all)
  • Health Policy
  • Health Informatics
  • Public Health, Environmental and Occupational Health

Cite this

Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines : HealthyHearts NYC. / Shelley, Donna R.; Ogedegbe, Olugbenga; Anane, Sheila; Wu, Winfred Y.; Goldfeld, Keith; Gold, Heather T.; Kaplan, Sue; Berry, Carolyn.

In: Implementation Science, Vol. 11, No. 1, 88, 2016.

Research output: Contribution to journalArticle

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