Implementation of Systematic Community Resource Referrals at Small Primary Care Practices to Promote Cardiovascular Disease Self-Management

Makelarski, Jennifer A.; DePumpo, Megan; Boyd, Kelly; Brown, Tiffany; Kho, Abel N.; Navalkha, Chenab; Lindau, Stacy Tessler

doi:10.1097/jhq.0000000000000234

Cited by 5 publications

(9 citation statements)

References 13 publications

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“…When presented with the QI opportunity to implement a standard, CVD-specific strategy for delivering community resource information to patients, more than one-half of practices randomized to the study arm that included CommunityRx-H3 either completed the inventory or requested customization of their HealtheRx-H3. 28 CommunityRx-H3 implementation and observations essential to this implementation science analysis were led by trained practice facilitators, a growing role in primary care practice improvement. To our knowledge, the current study is one of the first to investigate practice facilitators' perceptions and observations of implementation of a QI intervention to connect patients to community resources for heart health, the most understudied component of the Chronic Care Model.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, a HealtheRx-H3 was developed for each practice site, listing CVD prevention resources near or at each practice location. 28 To generate each HealtheRx-H3, practices were invited to complete an online inventory of CVD prevention resource information (name, contact information, operating hours, fees, available services) ( Table 1). Each HealtheRx-H3 was generated from the resource inventory and included an infographic with local countyand state-level ABCS-related statistics (eg, rates of hypertension-related hospitalization, costs attributable to CVD-related admissions, CVD-related death rates, and local tobacco quit line use rates [ Figure 2]).…”

Section: Interventionmentioning

confidence: 99%

“…22,23 Although there is a growing body of evidence about clinic-based interventions to facilitate community resource referrals for disease self-management and selfcare, [24][25][26] and large health systems are rapidly adopting community resource referral technologies, 27 little is known about small primary care practices' implementation of community resource referral strategies. 28,29 To address this gap, this study applies the Consolidated Framework for Implementation Research (CFIR) 30 to investigate practice facilitator perceptions and observations about CommunityRx-H3 implementation.…”

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confidence: 99%

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Implementation of Community-Based Resource Referrals for Cardiovascular Disease Self-Management

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Section: Discussionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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“…13 In addition, electronic health records (EHRs), could be used to prompt primary care clinicians to assess CVD risk factors and initiate referrals. 14 16 caution that widespread use of telehealth may widen disparities if precautions are not taken to address differential access to technology and broadband internet and concerns regarding confidentiality, privacy, and physical absence of a clinician. In addition, as highlighted in the USPSTF commissioned review, 2 further research on the impact of telehealth interventions is needed.…”

Section: Potential Solutionsmentioning

confidence: 99%

“…However, resources would need to be allocated to increase use of EHRs in smaller practices, provide the technical assistance needed to develop clinical decision-support systems Recommendations for Behavioral Counseling in Adults With Cardiovascular Disease Risk Factors EHR systems, establish appropriate referral networks, and assist patients in accessing services 14. Additional barriers to behavioral counseling access could be mitigated by expanded use of telehealth.…”

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confidence: 99%

USPSTF Recommendations for Behavioral Counseling in Adults With Cardiovascular Disease Risk Factors

2020

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The United States Preventive Services Task Force (USPSTF) has released new recommendations for adults with known cardiovascular disease (CVD) risk factors 1 and an associated systematic literature review. 2 The recommendations encourage medical practitioners to offer or refer adults with CVD risk factors to behavioral counseling interventions to promote healthy diet and physical activity (B recommendation). 1,2 Notable changes from the 2014 recommendations are that recommendations are extended to patients who are not overweight or obese (individuals who are overweight or obese are covered in other recommendations), CVD risk factors are expanded to include patients with elevated blood pressure and a 10-year CVD risk of 7.5% or greater, research pertaining to patients with impaired fasting glucose or diabetes is no longer included in the review but discussed in separate recommendation statements, and it is no longer specified that behavioral interventions should be intensive. 1 In addition, suggestions for implementation now state that behavioral counseling can be provided using media-based interventions. The systematic literature review 2 concluded that behavioral interventions produced a moderate net benefit, and resulted in lower incidence of CVD events; reductions in blood pressure, lower total cholesterol, and low-density lipoprotein cholesterol; and weight loss. Barriers to Implementation There are several barriers to implementing these USPSTF recommendations 1,2 in clinical settings. Owing to the expanded definition of CVD risk factors in this update, 1,2 behavioral counseling is recommended for a large proportion of, perhaps most, US adults. 3 Delivering behavioral counseling interventions to this large population would require substantial health systems change. Of 120 interventions in 94 studies included in the USPSTF commissioned review, 2 7 interventions (5.8%) were low intensity (ie, Յ30 minutes of contact), 59 interventions (49.2%) were medium intensity (ie, 31-360 minutes), and 54 interventions (45.0%) were high intensity (ie, >360 minutes). While some low-intensity interventions were effective, the most effective interventions in the studies reviewed included at least monthly contacts with patients over a period of 4 months or longer. 2 Interventions of this intensity may not be feasible in primary care settings owing to time constraints, increased care requirements of an aging population, competing clinical demands, and impending workforce shortages, and suboptimal geographic distribution of primary care clinicians. 4-6 While patients may want their primary care clinicians to provide lifestyle counseling, many primary care clinicians may not be familiar or experienced with communication techniques needed to engage and sustain behavior change in their patients 4,5,7 ; therefore, it is critical that behavioral counseling interventions are available to patients outside of primary care visits. As mentioned in the USPTF recommendations, 1 behavioral counseling services can be provided by nurses, register...

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Evidence-Based Quality Improvement: a Scoping Review of the Literature

et al. 2022

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Background Quality improvement (QI) initiatives often reflect approaches based on anecdotal evidence, but it is unclear how initiatives can best incorporate scientific literature and methods into the QI process. Review of studies of QI initiatives that aim to systematically incorporate evidence review (termed evidence-based quality improvement (EBQI)) may provide a basis for further methodological development. Methods In this scoping review (registration: https://osf.io/hr5bj) of EBQI, we searched the databases PubMed, CINAHL, and SCOPUS. The review addressed three central questions: How is EBQI defined? How is evidence used to inform evidence-informed QI initiatives? What is the effectiveness of EBQI? Results We identified 211 publications meeting inclusion criteria. In total, 170 publications explicitly used the term “EBQI.” Published definitions emphasized relying on evidence throughout the QI process. We reviewed a subset of 67 evaluations of QI initiatives in primary care, including both studies that used the term “EBQI” with those that described an evidence-based initiative without using EBQI terminology. The most frequently reported EBQI components included use of evidence to identify previously tested effective QI interventions; engaging stakeholders; iterative intervention development; partnering with frontline clinicians; and data-driven evaluation of the QI intervention. Effectiveness estimates were positive but varied in size in ten studies that provided data on patient health outcomes. Conclusions EBQI is a promising strategy for integrating relevant prior scientific findings and methods systematically in the QI process, from the initial developmental phase of the IQ initiative through to its evaluation. Future QI researchers and practitioners can use these findings as the basis for further development of QI initiatives.

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Implementation of Systematic Community Resource Referrals at Small Primary Care Practices to Promote Cardiovascular Disease Self-Management

Cited by 5 publications

References 13 publications

Implementation of Community-Based Resource Referrals for Cardiovascular Disease Self-Management

Implementation of Community-Based Resource Referrals for Cardiovascular Disease Self-Management

USPSTF Recommendations for Behavioral Counseling in Adults With Cardiovascular Disease Risk Factors

Evidence-Based Quality Improvement: a Scoping Review of the Literature

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