Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project
Background: Uncontrolled blood pressure (BP) is common among Veterans. Rural Veterans are at risk for suboptimal care coordination as successful programs may be implemented at lower rates due to individual- and system-level factors. There is strong evidence to support the use of remotely delivered s...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-03-01
|
| Series: | Contemporary Clinical Trials Communications |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451865421000089 |
| _version_ | 1818645501824729088 |
|---|---|
| author | Allison A. Lewinski Hayden B. Bosworth Karen M. Goldstein Jennifer M. Gierisch Shelley Jazowski Felicia McCant Courtney White-Clark Valerie A. Smith Leah L. Zullig |
| author_facet | Allison A. Lewinski Hayden B. Bosworth Karen M. Goldstein Jennifer M. Gierisch Shelley Jazowski Felicia McCant Courtney White-Clark Valerie A. Smith Leah L. Zullig |
| author_sort | Allison A. Lewinski |
| collection | DOAJ |
| description | Background: Uncontrolled blood pressure (BP) is common among Veterans. Rural Veterans are at risk for suboptimal care coordination as successful programs may be implemented at lower rates due to individual- and system-level factors. There is strong evidence to support the use of remotely delivered support and patient-generated data from home BP monitors and virtual BP visits to manage BP. Objective: The purpose of this project is to augment the current approach to addressing uncontrolled BP so that existing clinical staff can reach a larger patient population. Methods: Our project will address uncontrolled BP by leveraging team-based care, the Veteran's Health Administration Electronic Health Record, and patient-centered medical home data to address patient, provider, and system barriers to cardiovascular disease (CVD) preventive care. We will implement this project in cardiovascular disease practices in three rural Veterans Health Administration clinics. We will evaluate implementation processes as well as patient-level (e.g., clinical outcomes, referrals to specialty services) outcomes in a one-arm, pre-post design. Discussion: This manuscript describes our process in expanding the implementation of a successful project to improve BP control in high-risk, rural Veterans. Findings from our study will inform an understanding of both implementation and clinical effectiveness outcomes of a potentially scalable BP intervention in rural, community-based clinics. Appropriate management of Veterans with uncontrolled BP can reduce morbidity and mortality related to CVD. In turn, improvements in BP, can lead to improved quality metrics and potentially decrease costs for a healthcare system. |
| first_indexed | 2024-12-17T00:31:45Z |
| format | Article |
| id | doaj.art-b5718cce820647e39e4048ec056628b4 |
| institution | Directory Open Access Journal |
| issn | 2451-8654 |
| language | English |
| last_indexed | 2024-12-17T00:31:45Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Contemporary Clinical Trials Communications |
| spelling | doaj.art-b5718cce820647e39e4048ec056628b42022-12-21T22:10:16ZengElsevierContemporary Clinical Trials Communications2451-86542021-03-0121100705Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement projectAllison A. Lewinski0Hayden B. Bosworth1Karen M. Goldstein2Jennifer M. Gierisch3Shelley Jazowski4Felicia McCant5Courtney White-Clark6Valerie A. Smith7Leah L. Zullig8Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; School of Nursing, Duke University, Durham, NC, USA; Corresponding author. Durham VA Health Care System, HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA.Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; School of Nursing, Duke University, Durham, NC, USACenter of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USACenter of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USADepartment of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACenter of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USACenter of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USACenter of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USACenter of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USABackground: Uncontrolled blood pressure (BP) is common among Veterans. Rural Veterans are at risk for suboptimal care coordination as successful programs may be implemented at lower rates due to individual- and system-level factors. There is strong evidence to support the use of remotely delivered support and patient-generated data from home BP monitors and virtual BP visits to manage BP. Objective: The purpose of this project is to augment the current approach to addressing uncontrolled BP so that existing clinical staff can reach a larger patient population. Methods: Our project will address uncontrolled BP by leveraging team-based care, the Veteran's Health Administration Electronic Health Record, and patient-centered medical home data to address patient, provider, and system barriers to cardiovascular disease (CVD) preventive care. We will implement this project in cardiovascular disease practices in three rural Veterans Health Administration clinics. We will evaluate implementation processes as well as patient-level (e.g., clinical outcomes, referrals to specialty services) outcomes in a one-arm, pre-post design. Discussion: This manuscript describes our process in expanding the implementation of a successful project to improve BP control in high-risk, rural Veterans. Findings from our study will inform an understanding of both implementation and clinical effectiveness outcomes of a potentially scalable BP intervention in rural, community-based clinics. Appropriate management of Veterans with uncontrolled BP can reduce morbidity and mortality related to CVD. In turn, improvements in BP, can lead to improved quality metrics and potentially decrease costs for a healthcare system.http://www.sciencedirect.com/science/article/pii/S2451865421000089Cardiovascular diseasesPopulation health managementImplementation scienceQuality improvementVeterans |
| spellingShingle | Allison A. Lewinski Hayden B. Bosworth Karen M. Goldstein Jennifer M. Gierisch Shelley Jazowski Felicia McCant Courtney White-Clark Valerie A. Smith Leah L. Zullig Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project Contemporary Clinical Trials Communications Cardiovascular diseases Population health management Implementation science Quality improvement Veterans |
| title | Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project |
| title_full | Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project |
| title_fullStr | Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project |
| title_full_unstemmed | Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project |
| title_short | Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project |
| title_sort | improving cardiovascular outcomes by using team supported ehr leveraged active management disseminating a successful quality improvement project |
| topic | Cardiovascular diseases Population health management Implementation science Quality improvement Veterans |
| url | http://www.sciencedirect.com/science/article/pii/S2451865421000089 |
| work_keys_str_mv | AT allisonalewinski improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT haydenbbosworth improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT karenmgoldstein improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT jennifermgierisch improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT shelleyjazowski improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT feliciamccant improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT courtneywhiteclark improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT valerieasmith improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject AT leahlzullig improvingcardiovascularoutcomesbyusingteamsupportedehrleveragedactivemanagementdisseminatingasuccessfulqualityimprovementproject |