Abstract：
BACKGROUND: Cardiovascular disease (CVD) is the primary cause of premature morbidity and mortality in the United States and Tennessee ranks among the highest in CVD events. While patient-centered outcomes research (PCOR) evidence-based approaches that reach beyond the traditional doctor-patient visit hold promise to improve CVD care and prevent serious complications, most primary care providers lack time, knowledge, and infrastructure to implement these proven approaches. Statewide primary care quality improvement (QI) collaboratives hold potential to help address primary care needs, however, little is known regarding their effectiveness in improving uptake of PCOR evidence-based population health approaches and improving CVD outcomes. This study describes the design and implementation of a stepped-wedge cluster randomized controlled trial to assess the effectiveness of participation in a statewide quality improvement cooperative (The Tennessee Heart Health Network [TN-HHN]) on cardiovascular outcomes.
METHODS: The TN-HHN Effectiveness Study randomized 77 practices to 4 waves (i.e., clusters), with each wave beginning three months after the start of the prior wave and lasting for 18 months. All practice clusters received one of three Network interventions, and outcomes are measured for each three months both in the control phase and the intervention phase. Primary outcomes include Center for Medicare and Medicaid Services measures for aspirin use, blood pressure control, cholesterol control, and smoking cessation (ABCS).
CONCLUSIONS: This trial, upon its conclusion, will allow us to assess the effect of participation in a statewide quality improvement cooperative on cardiovascular outcomes as well as key contributors to successful practice transformation.
METHODS: The TN-HHN Effectiveness Study randomized 77 practices to 4 waves (i.e., clusters), with each wave beginning three months after the start of the prior wave and lasting for 18 months. All practice clusters received one of three Network interventions, and outcomes are measured for each three months both in the control phase and the intervention phase. Primary outcomes include Center for Medicare and Medicaid Services measures for aspirin use, blood pressure control, cholesterol control, and smoking cessation (ABCS).
CONCLUSIONS: This trial, upon its conclusion, will allow us to assess the effect of participation in a statewide quality improvement cooperative on cardiovascular outcomes as well as key contributors to successful practice transformation.
摘要：
背景：心血管疾病（CVD）是美国和田纳西州过早发病和死亡的主要原因，在CVD事件中排名最高。尽管以患者为中心的结果研究（PCOR）基于证据的方法超越了传统的医患访问，有望改善CVD护理并预防严重的并发症。大多数初级保健提供者缺乏时间，知识,和基础设施来实施这些行之有效的方法。全州初级保健质量改进（QI）合作具有帮助满足初级保健需求的潜力，然而,关于它们在改善PCOR循证人群健康方法的吸收和改善CVD结局方面的有效性知之甚少.本研究描述了阶梯式楔形集群随机对照试验的设计和实施，以评估参与全州质量改善合作社（田纳西州心脏健康网络[TN-HHN]）对心血管结局的有效性。
方法：TN-HHN有效性研究将77个实践随机分为4波（即，集群)，每一波都在前一波开始后三个月开始，持续18个月。所有实践集群都接受了三个网络干预之一，并且在控制阶段和干预阶段每三个月测量结果。主要结果包括医疗保险和医疗补助服务中心使用阿司匹林的措施，血压控制,胆固醇控制,戒烟（ABCS）。
结论：本试验，在它的结论，将使我们能够评估参与全州质量改善合作社对心血管结局的影响，以及成功实践转变的关键贡献者。
方法：TN-HHN有效性研究将77个实践随机分为4波（即，集群)，每一波都在前一波开始后三个月开始，持续18个月。所有实践集群都接受了三个网络干预之一，并且在控制阶段和干预阶段每三个月测量结果。主要结果包括医疗保险和医疗补助服务中心使用阿司匹林的措施，血压控制,胆固醇控制,戒烟（ABCS）。
结论：本试验，在它的结论，将使我们能够评估参与全州质量改善合作社对心血管结局的影响，以及成功实践转变的关键贡献者。
