IMPORTANCE Mobile applications (apps) may help improve hypertension self-management. OBJECTIVE To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app. DESIGN, SETTING, AND PARTICIPANTS This was a 2-group, open, randomized clinical trial.
Background:
Effective quality improvement (QI) strategies are needed for small practices.
Objective:
The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care.
Design:
Two arm, practice-randomized, comparative effectiveness study.
Participants:
Small and mid-sized primary care practices.
Interventions:
Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies.
Measures:
Proportion of eligible patients in a practice meeting “ABCS” measures: (Aspirin) Aspirin/antiplatelet therapy for ischemic vascular disease, (Blood pressure) Controlling High Blood Pressure, (Cholesterol) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease, and (Smoking) Tobacco Use: Screening and Cessation Intervention, and the Change Process Capability Questionnaire. Measurements were performed at baseline, 12, and 18 months.
Results:
A total of 226 practices were randomized, 179 contributed follow-up data. The mean proportion of patients meeting each performance measure was greater at 12 months compared with baseline: Aspirin 0.04 (95% confidence interval: 0.02–0.06), Blood pressure 0.04 (0.02–0.06), Cholesterol 0.05 (0.03–0.07), Smoking 0.05 (0.02–0.07); P<0.001 for each. Improvements were sustained at 18 months. At 12 months, baseline-adjusted difference-in-differences in proportions for the POC+PM arm versus POC was: Aspirin 0.02 (−0.02 to 0.05), Blood pressure −0.01 (−0.04 to 0.03), Cholesterol 0.03 (0.00–0.07), and Smoking 0.02 (−0.02 to 0.06); P>0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09–0.51) but did not significantly differ across arms.
Conclusion:
Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
Rheumatoid arthritis (RA) increases cardiovascular disease (CVD) risk. However, CVD risk factor identification and treatment is often inadequate. The authors implemented a multifaceted rheumatology practice intervention to improve CVD risk factor measurement, assessment, and management. The intervention included clinician education, point-of-care decision support, feedback, and care management. The authors measured quality indicators from electronic health records and assessed impact with interrupted time series. Following the intervention, more RA patients had all major CVD risk factors assessed (53% vs 72.2%), and the rate of increase was greater during the intervention period than baseline (difference of 0.74% per month, P = .0016). Moderate- or high-intensity statin prescribing increased (21.6% to 28.2%), but the rate of change was not different from baseline. Several other quality measures did not increase. Although CVD risk factor assessment improved, the intervention did not affect risk factor management and control. Other strategies are needed to optimize CVD prevention in RA.
Longitudinal analysis of supermarkets over time is essential to understanding the dynamics of foodscape environments for healthy living. Supermarkets for 2007, 2011, and 2014 for the City of Chicago were curated and further validated. The average distance to all supermarkets along the street network was constructed for each resident-populated census tract. These analytic results were generated with GIS software and stored as spatially enabled data files, facilitating further research and analysis. The data presented in this article are related to the research article entitled “Urban foodscape trends: Disparities in healthy food access in Chicago, 2007–2014” (Kolak et al., 2018).
PURPOSEIntegrating social care into clinical care requires substantial resources. Use of existing data through a geographic information system (GIS) has the potential to support efficient and effective integration of social care into clinical settings. We conducted a scoping literature review characterizing its use in primary care settings to identify and address social risk factors.
METHODSIn December 2018, we searched 2 databases and extracted structured data for eligible articles that (1) described the use of GIS in clinical settings to identify and/or intervene on social risks, (2) were published between December 2013 and December 2018, and (3) were based in the United States. Additional studies were identified by examining references.
RESULTSOf the 5,574 articles included for review, 18 met study eligibility criteria: 14 (78%) were descriptive studies, 3 (17%) tested an intervention, and 1 (6%) was a theoretical report. All studies used GIS to identify social risks (increase awareness); 3 studies (17%) described interventions to address social risks, primarily by identifying relevant community resources and aligning clinical services to patients' needs.CONCLUSIONS Most studies describe associations between GIS and population health outcomes; however, there is a paucity of literature regarding GIS use to identify and address social risk factors in clinical settings. GIS technology may assist health systems seeking to address population health outcomes through alignment and advocacy; its current application in clinical care delivery is infrequent and largely limited to referring patients to local community resources.
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