Using Practice Facilitation in Primary Care Settings to Reduce Risk Factors for Cardiovascular Disease

NCT ID: NCT02646488

Last Updated: 2019-05-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

276 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-08-31

Study Completion Date

2019-04-01

Brief Summary

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The primary purpose of this study is to 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. The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S). The long-term goal is to create a robust infrastructure to disseminate and implement evidence based practice guidelines (EBPG) findings in primary care practices and improve practices' capacity to receive and implement other EBPG findings in the future.

Detailed Description

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Conditions

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Cardiovascular Disease High Blood Pressure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Cluster 1

Consists of 80 sites chosen by block randomization in four waves every three months (80 in the first three waves and 60 in the last wave).

Group Type ACTIVE_COMPARATOR

Million Hearts ABCS 6 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Standard Care Regimen 9 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 12 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 15 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 18 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 21 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 24 Months

Intervention Type BEHAVIORAL

Cluster 2

Consists of 80 sites chosen by block randomization in four waves every three months (80 in the first three waves and 60 in the last wave).

Group Type ACTIVE_COMPARATOR

Million Hearts ABCS 6 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Million Hearts ABCS 9 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Standard Care Regimen 12 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 15 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 18 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 21 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 24 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 27 Months

Intervention Type BEHAVIORAL

Cluster 3

Consists of 80 sites chosen by block randomization in four waves every three months (80 in the first three waves and 60 in the last wave).

Group Type ACTIVE_COMPARATOR

Million Hearts ABCS 6 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Million Hearts ABCS 9 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Million Hearts ABCS 12 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Standard Care Regimen 15 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 18 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 21 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 24 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 27 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 30 Months

Intervention Type BEHAVIORAL

Cluster 4

Consists of 80 sites chosen by block randomization in four waves every three months (80 in the first three waves and 60 in the last wave).

Group Type ACTIVE_COMPARATOR

Million Hearts ABCS 6 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Million Hearts ABCS 9 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Million Hearts ABCS 12 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Million Hearts ABCS 15 Months

Intervention Type BEHAVIORAL

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Standard Care Regimen 18 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 21 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 24 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 27 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 30 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 33 Months

Intervention Type BEHAVIORAL

Interventions

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Million Hearts ABCS 6 Months

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Intervention Type BEHAVIORAL

Million Hearts ABCS 9 Months

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Intervention Type BEHAVIORAL

Million Hearts ABCS 12 Months

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Intervention Type BEHAVIORAL

Million Hearts ABCS 15 Months

The ABCS refer to the following: Aspirin in high-risk individuals (A), Blood pressure control and management (B), Cholesterol management (C), and Smoking cessation (S).

Intervention Type BEHAVIORAL

Standard Care Regimen 9 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 12 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 15 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 18 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 21 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 24 Months

Intervention Type BEHAVIORAL

Standard Care Regimen 27 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 21 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 24 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 27 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 30 Months

Intervention Type BEHAVIORAL

Follow Up Post Intervention 33 Months

Intervention Type BEHAVIORAL

Other Intervention Names

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Chronic Care Model

Eligibility Criteria

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Inclusion Criteria

* Eligibility includes working full or part time at the study site.


* Steering committee members or other key stakeholder from the following groups: Health Plan Chief Medical Officer, State health officials in the Chronic Disease Program, and leadership from relevant national associations (American Heart Association), members of Advisory Board of CHCANYS (these are physician leaders).


* at least one of the ABCS risk factors for CVD (i.e., hypertension, hyperlipidemia, eligible for aspirin and/or is a current smoker)
* must have received care at the clinic for at least 12 months
* Patients eligible for aspirin are those with a documented ICD-9 code for ischemic vascular disease in the last 12 months. Similarly, patients with a diagnosis of hypertension and/or hyperlipidemia will have a documented ICD-9 code for the targeted risk factor
* Smokers will be identified by a documented ICD-9 code, prescription for a cessation medication in the last 12 months or documentation in the chart (e.g. meaningful use measure) during the last 12 months (see outcome measures)
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role collaborator

NYU Langone Health

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Donna Shelley, MD

Role: PRINCIPAL_INVESTIGATOR

New York University Medical School

Locations

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New York University School of Medicine

New York, New York, United States

Site Status

Countries

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United States

References

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Gold HT, Siman N, Cuthel AM, Nguyen AM, Pham-Singer H, Berry CA, Shelley DR. A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: a cost analysis. Implement Sci Commun. 2021 Feb 6;2(1):15. doi: 10.1186/s43058-021-00116-x.

Reference Type DERIVED
PMID: 33549152 (View on PubMed)

Berry CA, Nguyen AM, Cuthel AM, Cleland CM, Siman N, Pham-Singer H, Shelley DR. Measuring Implementation Strategy Fidelity in HealthyHearts NYC: A Complex Intervention Using Practice Facilitation in Primary Care. Am J Med Qual. 2021 Jul-Aug 01;36(4):270-276. doi: 10.1177/1062860620959450.

Reference Type DERIVED
PMID: 32964719 (View on PubMed)

Shelley DR, Gepts T, Siman N, Nguyen AM, Cleland C, Cuthel AM, Rogers ES, Ogedegbe O, Pham-Singer H, Wu W, Berry CA. Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation. Am J Prev Med. 2020 May;58(5):683-690. doi: 10.1016/j.amepre.2019.12.013. Epub 2020 Feb 14.

Reference Type DERIVED
PMID: 32067871 (View on PubMed)

Gepts T, Nguyen AM, Cleland C, Wu W, Pham-Singer H, Shelley D. Accounting for Blood Pressure Seasonality Alters Evaluation of Practice-Level Blood Pressure Control Intervention. Am J Hypertens. 2020 Mar 13;33(3):220-222. doi: 10.1093/ajh/hpz179.

Reference Type DERIVED
PMID: 31711219 (View on PubMed)

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.

Reference Type DERIVED
PMID: 27377404 (View on PubMed)

Other Identifiers

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14-02042

Identifier Type: -

Identifier Source: org_study_id

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