Translating ATP III Cholesterol Management Guidelines Into Primary Care Practice
Condition: Hypercholesterolemia; Coronary Disease; Primary Health Care; Management, Risk
MeSH terms: Coronary Disease; Hypercholesterolemia
Study type: Observational

Summary: 
      This quality improvement trial aims to evaluate whether giving patients information about
      their coronary heart disease risk via a computer kiosk in the doctors waiting room and
      providing primary care doctors with a personal digital device with a decision support tool to
      help with cholesterol management will improve cholesterol management compared to usual care.
    

Detailed description: 
      This project will demonstrate and evaluate the translation of the ATP III Cholesterol
      management guidelines into primary care practice. During phase I, a needs assessment will
      evaluate barriers and facilitators to implementation of ATP III guidelines into clinical
      practice through focus groups of primary care patients and providers. Using formative
      evaluation and feedback from semi-structured individual interviews of patients and providers
      and participant observation during pilot testing in 6 primary care practices, three tools
      will be refined and tailored: a computerized patient activation tool based upon NHLBI
      web-based 10-year CHD risk score that will be placed in each primary care office's waiting
      room for patient use; an ATP III interactive guidelines tool for hand held device (PDA) to be
      used by primary care providers as a decision support tool at the point of care and academic
      detailing materials consisting of a practice manual, interactive, PowerPoint slides, and
      practice materials to be used during an academic detailing session. During phase 2, a block,
      randomized designed cluster trial will be performed with one year of intervention within
      primary care practices (30 practices/55 providers) throughout the state of Rhode Island and
      Southeastern New England to test the effectiveness of the materials developed in phase I to
      improve physician performance around ATP III guideline implementation and to improve
      clinically relevant outcomes, the percentage of patients with LDL-cholesterol at their ATP
      III goal. Products for dissemination from this grant will include the results of the focus
      groups barriers and facilitators to implementation of ATP III guidelines findings, a Medical
      Abstraction tool for quality of care assessment regarding ATP III guidelines, a refined
      computerized patient activation tool, a tailored ATP III interactive guideline tool for the
      PDA, tailored academic detailing materials and results of the randomized clinical trial on
      the effectiveness of these tools to improve primary care practice.
    

Intervention name(s): HeartAge intervention
Intervention type(s): Behavioral
Intervention description(s): Computerized kiosk in waiting room with HeartAge risk calculator, PDA based decision support tool regarding hyperlipidemia management, website and tool box with coronary risk reduction tools for smoking cessation, diet and exercise, medication adherence
Other intervention name(s): Cholesterol Education and Research Trial
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        stratified random sample of practices within those who agreed to participate; Cluster
        sampling of patients from practices
      
Keywords: quality improvement; implementation trials; cholesterol guidelines; patient activation