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Heart of Virginia Healthcare (HVH)

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ClinicalTrials.gov Identifier: NCT03054090
Recruitment Status : Completed
First Posted : February 15, 2017
Last Update Posted : November 9, 2018
Sponsor:
Collaborators:
Virginia Center for Health Innovation
Center for Health Policy Development
George Mason University
Health Quality Innovators
Agency for Healthcare Research and Quality (AHRQ)
Information provided by (Responsible Party):
Virginia Commonwealth University

Brief Summary:
Most care for chronic conditions is provided by primary care clinicians. Although Virginia ranks 4th among the 50 states in average income, it ranks 27th in mortality due to heart attacks and strokes. The scope and focus of this project will materially improve the rates of screening and treatment of risk factors for heart attacks and strokes, and will give primary care clinicians the tools and training to improve the care of other chronic illnesses and the delivery of preventive services.

Condition or disease Intervention/treatment Phase
Cardiovascular Diseases Other: Quality Improvement Support Not Applicable

Detailed Description:

Restoring Primary Care in Virginia: Patient Centered Outcomes Research (PCOR) Learning as a Pathway to Value is an extension of the Virginia Center for Health Innovation's (VCHI) work to address primary care transformation in its Virginia Health Innovation Plan. VCHI, in partnership with four of Virginia's schools of medicine, the Virginia Center for Health Quality (VHQC), and evaluation specialists at George Mason University, will form the Virginia Primary Care Transformation Collaborative (VPCTC). They will use an evidence-based, comprehensive strategy to help up to 300 small-to-medium sized primary care practices: 1) accelerate incorporation of PCOR clinical and organizational findings into practice with an initial focus on cardiovascular health and the Aspirin, Blood Pressure, Cholesterol, and Smoking (ABCS); 2) increase their capacity to integrate new PCOR findings on an on-going basis; and 3) learn strategies that can help them sustain and revitalize their organizations while restoring the joy to primary care practice. Practice supports will include on-site coaching, expert consultation, collaborative learning events, an online support center, and data feedback and benchmarking. As a result of this project, "Restoring Primary Care in Virginia," participating practices will develop stronger Quality Improvement (QI) capacity and learn strategies that can help them sustain and revitalize their organizations while restoring the joy to primary care practice. The value proposition to recruit and retain participating practices includes: Improved financial performance; improved clinician, staff, and patient satisfaction; objectively improved quality of care; improved ability to negotiate for and receive pay for performance bonuses, including Electronic Medical Record (EMR) meaningful use stage 2; completion of Part IV certification by the American Board of Family Medicine (ABFM) and American Board of Internal Medicine (ABIM) for QI work completed in this initiative; and engagement in a self-sustaining learning collaborative of similar practices after the end of the project. The evaluation plan is designed to answer these questions: (1) Did the VPCTC intervention improve the performance of small physician practices in Virginia as measured by the individual ABCS? (2) Which elements of the intervention were most important to the physicians for performance improvement? (3) Did "maintenance" or follow-up intervention activities add value or was the initial intense intervention enough to produce the measured impact? (4) Which internal contextual or structural features of practices at baseline are most likely to be associated with improved performance (e.g., expansive use of EMRs, degree of adaptive reserve or change processing capacity, number of physicians in the practice, etc.)? (5) Did the VPCTC improve the capacity of small physician practices to implement future PCOR findings and improve quality on an ongoing basis? (6) Which elements of the intervention were most important to the physicians for QI capacity building? Multivariate statistical modeling of clinical performance and survey data will be performed to answer questions 1, 3, and 4.

Qualitative interviews, surveys and statistical analysis of survey results will answer questions 2, 5, and 6.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 231 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Restoring Primary Care in Virginia: PCOR Learning as a Pathway to Value
Study Start Date : May 2015
Actual Primary Completion Date : September 30, 2018
Actual Study Completion Date : September 30, 2018

Arm Intervention/treatment
Quality Improvement support
A blended support strategy will include practice facilitation, expert consultation, collaborative learning events, an online support center, and data feedback and benchmarking.
Other: Quality Improvement Support
Practices will receive a blended strategy of quality improvement facilitation to help participating practices incorporate PCOR clinical and organizational findings while building their overall practice capabilities. Primary care practices will be provided tools and training to improve the rates of screening and treatment of risk factors for heart attacks and strokes, as well as other chronic illnesses and the delivery of preventive services.




Primary Outcome Measures :
  1. Aspirin prescriptions [ Time Frame: 3 month ]
    Practice level rates of aspirin or other anti-thrombotics being prescribed. The outcome measure will be assessed from data extracted from practice EMR.

  2. Blood pressure [ Time Frame: 3 months ]
    Blood pressure control for hypertensives. The outcome measure will be assessed from data extracted from practice EMR.

  3. Statin prescriptions [ Time Frame: 3 months ]
    Practice level rates of Statins being prescribed for categories of higher risk cholesterol levels. The outcome measure will be assessed from data extracted from practice EMR.

  4. Smoking [ Time Frame: 3 months ]
    Smoking assessment. The outcome measure will be assessed from data extracted from practice EMR.

  5. Smoking [ Time Frame: 3 months ]
    Smoking cessation counseling. The outcome measure will be assessed from data extracted from practice EMR.


Secondary Outcome Measures :
  1. Capacities to incorporate new patient centered outcome research [ Time Frame: 1 year after intervention ]
    Capacities of practices to incorporate new patient centered outcome research into their care of patients. This outcome measure will be assessed using surveys.

  2. Capacities to incorporate new patient centered outcome research [ Time Frame: 1 year after intervention ]
    Capacities of practices to incorporate new patient centered outcome research into their care of patients. This outcome measure will be assessed using interviews.

  3. Joy in practice [ Time Frame: 1 year after intervention ]
    This outcome measure will be assessed by way of surveys.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • small to medium sized primary care practices in virginia that serve adults

Exclusion Criteria:

  • large sized primary care practices
  • pediatric practices

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03054090


Sponsors and Collaborators
Virginia Commonwealth University
Virginia Center for Health Innovation
Center for Health Policy Development
George Mason University
Health Quality Innovators
Agency for Healthcare Research and Quality (AHRQ)
Investigators
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Principal Investigator: Anton Kuzel, MD Virginia Commonwealth University
Additional Information:
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Responsible Party: Virginia Commonwealth University
ClinicalTrials.gov Identifier: NCT03054090    
Other Study ID Numbers: 1R18HS023913-01 ( U.S. AHRQ Grant/Contract )
First Posted: February 15, 2017    Key Record Dates
Last Update Posted: November 9, 2018
Last Verified: November 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Virginia Commonwealth University:
Cardiovascular Diseases
Primary Care
Additional relevant MeSH terms:
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Cardiovascular Diseases