NYU Grossman School of Medicine, New York, NY, United States of America.
New York City Department of Health and Mental Hygiene, New York, NY, United States of America.
Contemp Clin Trials. 2023 Jun;129:107177. doi: 10.1016/j.cct.2023.107177. Epub 2023 Apr 8.
Only half of patients with hypertension have adequately controlled blood pressure. Clinical decision support (CDS) has the potential to overcome barriers to delivering guideline-recommended care and improve hypertension management. However, optimal strategies for scaling CDS have not been well established, particularly in small, independent primary care practices which often lack the resources to effectively change practice routines. Practice facilitation is an implementation strategy that has been shown to support process changes. Our objective is to evaluate whether practice facilitation provided with hypertension-focused CDS can lead to improvements in blood pressure control for patients seen in small primary care practices.
METHODS/DESIGN: We will conduct a cluster randomized control trial to compare the effect of hypertension-focused CDS plus practice facilitation on BP control, as compared to CDS alone. The practice facilitation intervention will include an initial training in the CDS and a review of current guidelines along with follow-up for coaching and integration support. We will randomize 46 small primary care practices in New York City who use the same electronic health record vendor to intervention or control. All patients with hypertension seen at these practices will be included in the evaluation. We will also assess implementation of CDS in all practices and practice facilitation in the intervention group.
The results of this study will inform optimal implementation of CDS into small primary care practices, where much of care delivery occurs in the U.S. Additionally, our assessment of barriers and facilitators to implementation will support future scaling of the intervention.
gov Identifier: NCT05588466.
只有一半的高血压患者血压得到了充分控制。临床决策支持（CDS）有可能克服提供指南推荐护理的障碍，并改善高血压管理。然而，尚未很好地确定扩大 CDS 的最佳策略，特别是在小型独立的初级保健实践中，这些实践通常缺乏有效改变实践常规的资源。实践促进是一种实施策略，已被证明可以支持流程的改变。我们的目标是评估针对高血压的 CDS 与实践促进相结合是否可以改善小型初级保健实践中患者的血压控制。
方法/设计：我们将进行一项群组随机对照试验，比较以高血压为重点的 CDS 加实践促进对血压控制的影响，与 CDS 单独使用相比。实践促进干预将包括 CDS 的初始培训以及对当前指南的审查，以及后续的辅导和整合支持。我们将随机选择纽约市的 46 家使用相同电子健康记录供应商的小型初级保健实践进行干预或对照。这些实践中所有患有高血压的患者都将被纳入评估。我们还将评估所有实践中 CDS 的实施情况和干预组中实践促进的实施情况。
这项研究的结果将为在美国开展的小型初级保健实践中最佳实施 CDS 提供信息。此外，我们对实施障碍和促进因素的评估将支持未来对干预措施的推广。
gov 标识符：NCT05588466。
