Heart of Virginia Healthcare

Cardiovascular Diseases Clinical Trial

— HVH  

Official title:

Restoring Primary Care in Virginia: PCOR Learning as a Pathway to Value

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03054090
• Other study ID #: 1R18HS023913-01
• Status: Completed
• Phase: N/A
• Start date: May 2015
• Est. completion date: September 30, 2018

Study information

• Verified date: November 2018
• Source: Virginia Commonwealth University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Most care for chronic conditions is provided by primary care clinicians. Although Virginia ranks 4th among the 50 states in average income, it ranks 27th in mortality due to heart attacks and strokes. The scope and focus of this project will materially improve the rates of screening and treatment of risk factors for heart attacks and strokes, and will give primary care clinicians the tools and training to improve the care of other chronic illnesses and the delivery of preventive services.

Description:

Restoring Primary Care in Virginia: Patient Centered Outcomes Research (PCOR) Learning as a Pathway to Value is an extension of the Virginia Center for Health Innovation's (VCHI) work to address primary care transformation in its Virginia Health Innovation Plan. VCHI, in partnership with four of Virginia's schools of medicine, the Virginia Center for Health Quality (VHQC), and evaluation specialists at George Mason University, will form the Virginia Primary Care Transformation Collaborative (VPCTC). They will use an evidence-based, comprehensive strategy to help up to 300 small-to-medium sized primary care practices: 1) accelerate incorporation of PCOR clinical and organizational findings into practice with an initial focus on cardiovascular health and the Aspirin, Blood Pressure, Cholesterol, and Smoking (ABCS); 2) increase their capacity to integrate new PCOR findings on an on-going basis; and 3) learn strategies that can help them sustain and revitalize their organizations while restoring the joy to primary care practice. Practice supports will include on-site coaching, expert consultation, collaborative learning events, an online support center, and data feedback and benchmarking. As a result of this project, "Restoring Primary Care in Virginia," participating practices will develop stronger Quality Improvement (QI) capacity and learn strategies that can help them sustain and revitalize their organizations while restoring the joy to primary care practice. The value proposition to recruit and retain participating practices includes: Improved financial performance; improved clinician, staff, and patient satisfaction; objectively improved quality of care; improved ability to negotiate for and receive pay for performance bonuses, including Electronic Medical Record (EMR) meaningful use stage 2; completion of Part IV certification by the American Board of Family Medicine (ABFM) and American Board of Internal Medicine (ABIM) for QI work completed in this initiative; and engagement in a self-sustaining learning collaborative of similar practices after the end of the project. The evaluation plan is designed to answer these questions: (1) Did the VPCTC intervention improve the performance of small physician practices in Virginia as measured by the individual ABCS? (2) Which elements of the intervention were most important to the physicians for performance improvement? (3) Did "maintenance" or follow-up intervention activities add value or was the initial intense intervention enough to produce the measured impact? (4) Which internal contextual or structural features of practices at baseline are most likely to be associated with improved performance (e.g., expansive use of EMRs, degree of adaptive reserve or change processing capacity, number of physicians in the practice, etc.)? (5) Did the VPCTC improve the capacity of small physician practices to implement future PCOR findings and improve quality on an ongoing basis? (6) Which elements of the intervention were most important to the physicians for QI capacity building? Multivariate statistical modeling of clinical performance and survey data will be performed to answer questions 1, 3, and 4.

Qualitative interviews, surveys and statistical analysis of survey results will answer questions 2, 5, and 6.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 231
• Est. completion date: September 30, 2018
• Est. primary completion date: September 30, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• small to medium sized primary care practices in virginia that serve adults

Exclusion Criteria:

• large sized primary care practices

• pediatric practices

Related Conditions & MeSH terms

• Cardiovascular Diseases

Intervention

Other:
• Quality Improvement Support
Practices will receive a blended strategy of quality improvement facilitation to help participating practices incorporate PCOR clinical and organizational findings while building their overall practice capabilities. Primary care practices will be provided tools and training to improve the rates of screening and treatment of risk factors for heart attacks and strokes, as well as other chronic illnesses and the delivery of preventive services.

Locations

Country	Name	City	State
n/a

Sponsors (6)

Lead Sponsor	Collaborator
Virginia Commonwealth University	Agency for Healthcare Research and Quality (AHRQ), Center for Health Policy Development, George Mason University, Health Quality Innovators, Virginia Center for Health Innovation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Aspirin prescriptions	Practice level rates of aspirin or other anti-thrombotics being prescribed. The outcome measure will be assessed from data extracted from practice EMR.	3 month
Primary	Blood pressure	Blood pressure control for hypertensives. The outcome measure will be assessed from data extracted from practice EMR.	3 months
Primary	Statin prescriptions	Practice level rates of Statins being prescribed for categories of higher risk cholesterol levels. The outcome measure will be assessed from data extracted from practice EMR.	3 months
Primary	Smoking	Smoking assessment. The outcome measure will be assessed from data extracted from practice EMR.	3 months
Primary	Smoking	Smoking cessation counseling. The outcome measure will be assessed from data extracted from practice EMR.	3 months
Secondary	Capacities to incorporate new patient centered outcome research	Capacities of practices to incorporate new patient centered outcome research into their care of patients. This outcome measure will be assessed using surveys.	1 year after intervention
Secondary	Capacities to incorporate new patient centered outcome research	Capacities of practices to incorporate new patient centered outcome research into their care of patients. This outcome measure will be assessed using interviews.	1 year after intervention
Secondary	Joy in practice	This outcome measure will be assessed by way of surveys.	1 year after intervention

External Links

•   Primary Care Facilitation Guide
•   Quality improvement Guide
•   Vital Signs: Avoidable Deaths from Heart Disease, Stroke, and Hypertensive Disease — United States, 2001-2010