Southwest Health Extension Partnership to Enhance Research Dissemination

Cardiovascular disease (CVD) causes one in three deaths reported each year in the United
States. Strategies derived from patient-centered outcomes research (PCOR) that address CVD
risk factors can greatly reduce the burden of CVD. Primary care practices must transform to
deliver a higher level of PCOR evidence-based prevention to decrease cardiovascular risk.
PCOR interventions that emphasize patient-centered care including self-management support,
team-based care, improved information systems, and active quality improvement have been shown
to be effective. Practices often require assistance integrating new programs into clinical
operations. Practice facilitation has been shown to enhance implementation of new programs
for patients with chronic disease in primary care. Other methods of practice support,
including academic detailing, collaborative learning sessions, and health information
technology assistance, have also been shown to be effective, by themselves and in combination
with practice facilitation. Patient involvement may also aid practice transformation.
Increasingly, practices are actively including patients as part of the change process through
the creation of patient advisory councils and including patients in practice quality
improvement teams. Another method of patient involvement to inform implementation of
evidence-based care is the Boot Camp Translation process, in which patients collaborate with
primary care clinicians, staff members, and community members to translate best practices
into culturally and community relevant implementation at the local level. However, while
these efforts have had considerable success, no study has looked at the incremental value of
adding patient engagement strategies to the more standard approaches to practice
transformation listed above. This project would implement the Southwest Health Extension
Program to Enhance Research Dissemination (SHEPERD) as a cooperative program to build primary
care practice capacity for quality improvement, change management, and implementation of PCOR
findings in small and medium size primary care practices in Colorado and New Mexico, with an
initial focus on cardiovascular care. It also would conduct a cluster randomized trial with
an external matched cohort control group to examine the Reach, Effectiveness, Adoption,
Implementation, and Maintenance of two approaches to practice transformation to implement
PCOR interventions for reducing cardiovascular risks in primary care practices, comparing the
impact of 1) a standard practice transformation support intervention (including practice
facilitation, practice assessment with feedback, HIT assistance, academic detailing, and
collaborative learning sessions) to 2) an approach that adds patient engagement activities
(including patient advisory councils and boot camp translation) as part of the practice
transformation support. This project will provide critical information regarding the added
value of patient engagement in practice transformation efforts and will also result in a
network of practices across the region with increased capacity for practice transformation
and implementation of PCOR findings.

Inclusion Criteria:

- Must be staff or clinicians (including physicians, nurse practitioners, and physician
assistants) in an enrolled primary care practice

- Primary care practices must be family medicine or general internal medicine practices
with a maximum of ten lead clinicians

- Primary care practices must be either independent or, if part of a larger
organization, demonstrate on careful screening that they do not receive significant
quality improvement support from the larger organization

Exclusion Criteria:

- Primary care practices with more than 10 lead clinicians

- Non-independent primary care practices that receive significant quality improvement
support from their system or organization

- Clinicians and staff who do not speak or read English