Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES)
Study Details
Study Description
Brief Summary
The purpose of this study is to evaluate approximately eight grants that will test interventions to improve cardiovascular disease prevention. The investigators will collect and analyze qualitative data to identify the most effective combinations of intervention strategies. The investigators will observe grantees and selected practices to understand why and how those combinations are effective. The investigators will also gather data from the grantees to assess how effective the interventions are.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
The purpose of this study is to evaluate approximately eight different R18 grants that will test practice change interventions to improve cardiovascular disease (CVD) prevention screening. The investigators will collect and analyze quantitative data (context, process, and outcomes) to identify the most effective combinations of intervention strategies for various practice types in relation to practice structure, context, and organizational characteristics associated with change in outcomes. The investigators will collect qualitative data (observation, interviews, online diaries) from grantees and selected practices to understand why and how those combinations are effective. The investigators will also gather documents and de-identified quantitative data from grantees.
Evidence clearly shows that many people do not receive guideline-concordant health care; this is true even for low cost treatments such as Aspirin prescribing, Blood pressure and Cholesterol control and Smoking cessation (the ABCS) known to prevent cardiovascular disease (CVD). In hospitals and integrated care systems with substantial resources, large quality improvement campaigns have been shown to increase adherence to guidelines by creating communities of learning that change behavior on a large scale. Agency for Healthcare Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI) are partnering to launch a campaign to promote the improvement of guideline-based CVD preventive care in small primary care practices with limited resources and experience with quality improvement ("Implementation" RFA-HS-14-008). The practices for each of these R18 grants will be in a contiguous geographic region. This study will evaluate each of these R18 implementation grants.
The investigators' strategy is to conduct a prospective observational analysis to evaluate the effectiveness of the R18s ABCS quality improvement initiatives. To do this, the investigators will collect and analyze qualitative data to identify the most effective combinations of intervention strategies for various practice types, contexts, and organizational characteristics, and to understand why and how those combinations are effective. The investigators will also gather de-identified quantitative data that the R18s collected.
Study Design
Outcome Measures
Primary Outcome Measures
- Percentage of participants with AMI, coronary artery bypass graft, PCI or IVD, and who had documentation of used of aspirin or another antithrombotic during the measurement period. [Quarterly for 4 years]
Acute myocardial infarction (AMI), ischemic vascular disease (IVD), percutaneous coronary interventions (PCI)
- Percentage of participants with diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period. [Quarterly for 4 years]
- Percentage of participants considered at high risk of cardiovascular events who were prescribed or were on a statin therapy during the measurement period. [Quarterly for 4 years]
- Percentage of participants who were screened for tobacco use and received cessation counseling intervention if identified as a tobacco user. [Quarterly for 4 years]
Secondary Outcome Measures
- Practice capacity for change measured by adaptive reserve (AR) [Baseline, immediately after intervention, 6 months post-intervention (4 years maximum)]
- Practice capacity for quality improvement measured by CPCQ [Baseline, immediately after intervention, 6 months post-intervention (4 years maximum)]
Eligibility Criteria
Criteria
Inclusion Criteria:
- All R18 grant awardees are included in the study.
Exclusion Criteria:
- N/A
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Oregon Health and Science University
- University of Texas
- Rutgers University
- HealthPartners Institute
- University of Michigan
- Case Western Reserve University
Investigators
- Principal Investigator: Debbie Cohen, PhD, OHSU, Department of Family Medicine
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Cohen DJ, Balasubramanian BA, Gordon L, Marino M, Ono S, Solberg LI, Crabtree BF, Stange KC, Davis M, Miller WL, Damschroder LJ, McConnell KJ, Creswell J. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol. Implement Sci. 2016 Jun 29;11(1):86. doi: 10.1186/s13012-016-0449-8.
- Kaufman A, Rhyne RL, Anastasoff J, Ronquillo F, Nixon M, Mishra S, Poola C, Page-Reeves J, Nkouaga C, Cordova C, Larson RS. Health Extension and Clinical and Translational Science: An Innovative Strategy for Community Engagement. J Am Board Fam Med. 2017 Jan 2;30(1):94-99. doi: 10.3122/jabfm.2017.01.160119.
- Parchman ML, Fagnan LJ, Dorr DA, Evans P, Cook AJ, Penfold RB, Hsu C, Cheadle A, Baldwin LM, Tuzzio L. Study protocol for "Healthy Hearts Northwest": a 2 × 2 randomized factorial trial to build quality improvement capacity in primary care. Implement Sci. 2016 Oct 13;11(1):138.
- Reck J. Primary care provider burnout: implications for states & strategies for mitigation. National Academy for State Health Policy. 2017 Jan.
- Shelley DR, Ogedegbe G, Anane S, Wu WY, Goldfeld K, Gold HT, Kaplan S, Berry C. Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC. Implement Sci. 2016 Jul 4;11(1):88. doi: 10.1186/s13012-016-0450-2.
- Solberg LI, Kuzel A, Parchman ML, Shelley DR, Dickinson WP, Walunas TL, Nguyen AM, Fagnan LJ, Cykert S, Cohen DJ, Balasubramanaian BA, Fernald D, Gordon L, Kho A, Krist A, Miller W, Berry C, Duffy D, Nagykaldi Z. A Taxonomy for External Support for Practice Transformation. J Am Board Fam Med. 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225.
- Solberg LI. What do we know and need to know about transforming primary care? Fam Pract. 2017 Aug 1;34(4):371-372. doi: 10.1093/fampra/cmx031.
- Weiner BJ, Pignone MP, DuBard CA, Lefebvre A, Suttie JL, Freburger JK, Cykert S. Advancing heart health in North Carolina primary care: the Heart Health NOW study protocol. Implement Sci. 2015 Nov 14;10:160. doi: 10.1186/s13012-015-0348-4.
- 11482