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Tennessee Heart Health Network: implementing patient-centered practices in primary care to improve cardiovascular health
Investigator (PI): Bailey, James E; Heavrin, Benjamin S
Performing Organization (PO): (Current): University of Tennessee Health Science Center, Center for Health System Improvement / (901) 448-2475
Supporting Agency (SA): Agency for Healthcare Research and Quality (AHRQ)
Initial Year: 2021
Final Year: 2024
Record Source/Award ID: RePorter/ U18HS027952
Funding: 2021 Award Amount: $1,519,716
Award Type: Cooperative Agreement
Abstract: Cardiovascular disease (CVD) is the primary cause of premature morbidity and mortality in the United States. Tennessee ranks third in the U.S. in CVD event rates, sixth in CVD mortality, and fifth in stroke mortality. The state's high prevalence of CVD is primarily linked to its disproportionate burden of CVD risk factors, including obesity, diabetes, and hypertension, and their associated modifiable health behaviors, including poor nutrition, sedentary lifestyle, and tobacco use. Patient-centered medical home initiatives hold some promise for reducing the burden of CVD in Tennessee. But these value-based purchasing endeavors have been insufficient by themselves to support busy primary care practices in implementing patient-centered outcomes research (PCOR) approaches that reach beyond the traditional doctor-patient visit. An insufficient pipeline of primary care providers has made it even more critical to implement team-based care approaches that employ telehealth and lay community health workers to engage patients in better self-care. Yet primary care providers and their team members have little time, knowledge, or resources to identify and implement these proven and financially sustainable PCOR evidence-based population health approaches. The goal of the Tennessee Heart Health Network is to leverage existing infrastructure by identifying and implementing appropriate evidence-based interventions to improve quality and outcomes of CVD care across Tennessee. We will particularly target hypertension control and smoking cessation as two of the most potent CVD risk factors to reduce and/or eliminate disparities in CVD outcomes and risks. We aim to 1) establish a statewide cooperative external quality improvement (QI) support infrastructure; 2) build a network of primary care practices and related stakeholders who can utilize the cooperative as a resource for QI support; 3) develop a comprehensive, multicomponent, evidence-based approach for a heart health improvement project to improve delivery of PCOR and build internal improvement capacity; 4) conduct a robust evaluation of all phases of the project; 5) disseminate interim findings; and 6) integrate sustainability planning and develop a plan to maintain the cooperative and its network of practices and professionals beyond the conclusion of the project. We expect to help primary care practices implement PCOR findings for Tennessee's priority populations (e.g., African Americans with hypertension and people with obesity, diabetes, and CVD) to transform primary care and measurably improve heart health care and outcomes.
MeSH Terms:
  • Community Health Workers
  • Evidence-Based Medicine
  • Healthcare Disparities
  • * Heart Diseases /*prevention & control
  • Humans
  • * Primary Health Care
  • Self-Care
  • Tennessee
Country: United States
State: Tennessee
Zip Code: 38163
UI: 20212316
Project Status: Ongoing