Healthy Hearts in the Heartland
Condition: Cardiovascular Diseases
MeSH terms: Cardiovascular Diseases
Study type: Interventional

Summary: 
      This study evaluates the ability of small primary care practices to 1) implement
      point-of-care and population management quality improvement strategies to improve
      cardiovascular quality of care (e.g., clinical decision support, patient education and
      counseling, or referral to smoking quit lines), and 2) implement the PopHealth performance
      measurement software to evaluate performance on the ABCS (aspirin when appropriate, blood
      pressure control, cholesterol management, and when applicable, smoking cessation) and allow
      regional benchmarking. This minimal risk study is a practice-randomized trial to determine a)
      whether point of care strategies improve ABCS performance measures compared to baseline, and
      b) whether adding locally tailored population management strategies to POC strategies
      improves performance on the ABCS measures more than POC strategies alone.
    

Detailed description: 
      The investigators specific aims are to:

        1. Evaluate the ability of small practices in the investigators region to 1) implement
           point-of-care (POC) and population management (PM) quality improvement strategies to
           improve the ABCS, and 2) implement the popHealth quality measurement software to
           evaluate performance on the ABCS and allow regional benchmarking.

        2. Conduct a practice-randomized trial to determine a) whether POC strategies improve ABCS
           performance measures (i.e. aspirin prescribing, blood pressure control, cholesterol
           management, and smoking cessation counseling) compared to baseline, and b) whether
           adding locally-tailored PM strategies to POC strategies improves performance on the ABCS
           measures more than POC strategies alone.

        3. Deploy an open source quality measurement platform (popHealth) to establish a regional
           QI benchmark based on participating practice ABCS measures and enable longitudinal
           tracking of electronic clinical quality measures (eCQMs) across the investigators
           region. The investigators will perform a mixed-methods evaluation to examine changes in
           practices' perceived capacity for quality improvement and whether access to comparative
           quality data within a region improves the capacity of practices to sustain their quality
           improvement program around the ABCS and provides a long-term framework for practices to
           implement new QI activities.
    

Intervention name(s): Point of Care; Population Management
Intervention type(s): Other; Other
Intervention description(s): Practice facilitators will work with practices to implement strategies to improve ABCS care during the patient encounter. Some examples of these types of quality improvement initiatives are electronic reminders and clinical decision support to prescribe aspirin or a statin at the time of a visit, improving how your practice collects blood pressure measures to increase clinicians' willingness to act on readings, or electronic reminders for nursing staff that there is no lipid panel in record and have a standing order to act on this.; Practice Facilitators will work with practices to both implement Point of Care strategies as well as population management strategies. These practices will use their EHR and/or receive training to use the popHealth software package, which works with data from the EHR, to generate lists of high-risk patients that need outreach for one of the ABCS domains (such as conducting outreach to patients who are not on aspirin who would benefit from this therapy).
Practices in this arm will receive the opportunity to link to community resources such as pharmacists who could assist patients with medication management or tobacco quit lines through the HealtheRx program.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Preventive measures; Quality Improvement