Guideline Adherence for a Healthy Heart
GLAD Heart is a practice-based research project funded by the National Heart, Lung, and Blood Institute.
It is taking place in primary care practices across North Carolina and is implemented by investigators at
Wake Forest University’s Division of Public Health Sciences.
The goal of the GLADHeart trial is to test the impact of a novel practice-based intervention, which includes the use of a personal digital assistant (PDA) based decision support tool, on adherence to a complex clinical practice guideline (CPG) in primary care practices. We have chosen the ATPIII guideline for several reasons. Primary and secondary prevention interventions lowering high blood cholesterol are effective in reducing the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. Evidence regarding cholesterol management indicates that significant opportunities exist for quality improvement, as eligible patients are not screened, and many, including those with coronary heart disease (CHD), are not treated to appropriate goals. The ATPIII guidelines are complex and include screening criteria, risk stratification, and risk-group specific treatment thresholds and goals. The complexity of the ATPIII guideline is especially challenging among patients without established CVD or diabetes mellitus (DM). We focus on primary-care physicians, as they are the most appropriate target group, because they decide whether to screen and manage cholesterol for the vast majority of eligible patients.
This trial addresses the challenges associated with implementation of ATPIII and is motivated by our interest in gaining insight
regarding the following general research questions about CPG implementation:
||Can physician adherence to complex CPGs be promoted by use of a hand-held computerized decision support tool providing patient-specific recommendations, documentation, and drug dosing assistance?
||Will increased adherence to CPGs reduce variation in management by age, gender and race/ethnicity such that disparities in healthcare are reduced or eliminated?
||What are the cost implications of using PDA-based technology to promote CPG adherence?