title: Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC.
abstract: HealthyHearts NYC (HHNYC) will evaluate the effectiveness of practice facilitation as a quality improvement strategy for implementing the Million Hearts' ABCS treatment guidelines for reducing cardiovascular disease (CVD) among high-risk patients who receive care in primary care practices in New York City. ABCS refers to (A) aspirin in high-risk individuals; (B) blood pressure control; (C) cholesterol management; and (S) smoking cessation. The long-term goal is to create a robust infrastructure for implementing and disseminating evidence-based practice guidelines (EBPG) in primary care practices.
  
  
  
  We are using a stepped-wedge cluster randomized controlled trial design to evaluate the implementation process and the impact of practice facilitation (PF) versus usual care on ABCS outcomes in 250 small primary care practices. Randomization is at the practice site level, all of which begin as part of the control condition. The intervention consists of one year of PF that includes a combination of one-on-one onsite visits and shared learning across practice sites. PFs will focus on helping sites implement evidence-based components of patient-centered medical home (PCMH) and the chronic care model (CCM), which include decision support, provider feedback, self-management tools and resources, and linkages to community-based services.
  
  
  
  We hypothesize that practice facilitation will result in superior clinical outcomes compared to usual care; that the effects of practice facilitation will be mediated by greater adoption of system changes in accord with PCMH and CCM; and that there will be increased adaptive reserve and change capacity.
  
  
  
  NCT02646488.
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA. donna.shelley@nyumc.org.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Shelley
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Primary Care Information Project, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Anane
authors.affiliation: Primary Care Information Project, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
authors.forename: Winfred Y
authors.initials: WY
authors.lastname: Wu
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Goldfeld
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
authors.forename: Heather T
authors.initials: HT
authors.lastname: Gold
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Kaplan
authors.affiliation: Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Berry
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D016000:Cluster Analysis; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D009519:New York City; D010349:Patient Compliance; D015397:Program Evaluation / Q000379:methods*; D012107:Research Design
keywords: Cardiovascular disease; Practice facilitation; Primary care