Background
Methods
Study setting and recruitment
Study design
Practice support interventions
Practice facilitation and support
Change concept | Description of practice activities |
---|---|
Embed clinical evidence on ABCS into daily work to guide care for patients | ▪ Review the evidence supporting the ABCS for primary and secondary prevention of cardiovascular risk ▪ Review treatment guidelines for ABCS measures ▪ Educate staff on clinical guidelines ▪ Select patient education materials for primary and secondary prevention |
Utilize reliable, robust data to understand and improve ABCS measures | ▪ Develop process to pull data from EMR ▪ Review data for accuracy and build confidence in data ▪ Develop process to support accurate data entry/collection ▪ Use data to identify gaps between the evidence-based guidelines and current care for all patients on panel ▪ Create population-based reports and visual data dashboards |
Establish a regular QI process involving cross-functional teams | ▪ Set aside regular meeting time for cross-functional QI team ▪ Select a QI methodology to structure improvement efforts ▪ Train team members on QI methodology ▪ Practice good meeting skills ▪ Regularly review data on ABCS outcome and process measures to understand areas for improvement ▪ Invite patient(s) to participate on the QI team |
Identify at-risk patients for prevention outreach | ▪ Understand current patient panel relative to ABCS ▪ Select actionable improvement goals based on ABCS data ▪ Recall patients overdue for care/outreach related to ABCS testing, education, counseling |
Define roles and responsibilities (tasks) across the care team to identify and manage ABCS population | ▪ Use workflow mapping to examine current processes and explore other approaches ▪ Introduce preventive screenings and educational materials for ABCS measures into workflow ▪ Develop/enable point of care reminders based on ABCS guidelines ▪ Scrub charts daily to flag patients needing support on ABCS |
Deepen patient self-management support for action planning around ABCS | ▪ Train staff in motivational interviewing ▪ Develop shared care plans with patients, emphasizing goal setting led by patient values ▪ Follow up with patient progress toward care plan goals |
Develop robust linkage to smoking cessation, self-management programs, and other evidence-based community resources | ▪ Create list of community resources and keep in a location accessible to all staff members ▪ Outreach to community resources to build referral pathway ▪ Provide list of resources to patients ▪ Proactively refer patients to community resources and assist in establishing patient with the resource |
Shared learning opportunities through site visits
Educational outreach
Data collection and measures
Construct | Data source | Measure(s) | Timing |
---|---|---|---|
Practice capacity for quality improvement (QI) | Quality improvement capacity assessment (QICA) survey | • Eight change concepts (see Table 1) | Baseline and 9–12 months after start of practice facilitation |
Prior experience with QI | Practice survey | • Change process capacity questionnaire (CPCQ) [21] | Baseline and 4 months after exposure to enhanced support interventions |
External organizational support for QI | Practice survey | • Is the practice is part of a large organization with a centralized QI team? • The autonomy of the practice to choose what QI projects they wish to work on | Baseline and 4 months after exposure to enhanced support interventions |
External climate for QI | Practice survey | • Location of practice: Washington, Oregon, or Idaho | Baseline and 4 months after exposure to enhanced support interventions |
Adaptive reserve | Staff survey | • Adaptive reserve scale [22] | Baseline and 4 months after exposure to enhanced support interventions |
Clinical quality measures for ABCS CVD risk factors | Numerator and denominator report generated by each practice from their Electronic Health Record | • NQF0068: ischemic vascular disease: appropriate use of aspirin/antithrombotic • NQF0018: controlling high blood pressure • NQF0028: preventive care and screening: tobacco use • CMS proposed statin measure | Every 90 days with a 12 month look-back period |