U18HS027952

Tennessee Heart Health Network: Implementing Patient-Centered Practices in Primary Care to Improve Cardiovascular Health - Abstract

Cardiovascular disease (CVD) is the primary cause of premature morbidity and mortality in the United States. Tennessee ranks 3rd in the U.S. in CVD event rates, 6th in CVD mortality, and 5th 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.

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.

University Of Tennessee

TO SUPPORT RESEARCH AND EVALUATIONS, DEMONSTRATION PROJECTS, RESEARCH NETWORKS, AND MULTIDISCIPLINARY CENTERS AND TO DISSEMINATE INFORMATION ON HEALTH CARE AND ON SYSTEMS FOR THE DELIVERY OF SUCH CARE INVOLVING: (1) THE QUALITY, EFFECTIVENESS, EFFICIENCY, APPROPRIATENESS AND VALUE OF HEALTH CARE SERVICES, (2) QUALITY MEASUREMENT AND IMPROVEMENT, (3) THE OUTCOMES, COST, COST-EFFECTIVENESS, AND USE OF HEALTH CARE SERVICES AND ACCESS TO SUCH SERVICES, (4) CLINICAL PRACTICE, INCLUDING PRIMARY CARE AND PRACTICE-ORIENTED RESEARCH, (5) HEALTH CARE TECHNOLOGIES, FACILITIES AND EQUIPMENT, (6) HEALTH CARE COSTS, PRODUCTIVITY, ORGANIZATION, AND MARKET FORCES, (7) HEALTH PROMOTION AND DISEASE PREVENTION, INCLUDING CLINICAL PREVENTIVE SERVICES, (8) HEALTH STATISTICS, SURVEYS, DATABASE DEVELOPMENT, AND EPIDEMIOLOGY, (9) DIGITAL HEALTHCARE RESEARCH, AND (10) PATIENT SAFETY RESEARCH, INCLUDING HEALTHCARE-ASSOCIATED INFECTIONS. IN SUPPORT OF THIS RESEARCH, THE AGENCY HAS A SPECIAL INTEREST IN HEALTH CARE AND ITS DELIVERY IN THE INNER CITY, IN RURAL AREAS, AND FOR PRIORITY POPULATIONS (LOW-INCOME GROUPS, MINORITY GROUPS, WOMEN, CHILDREN, THE ELDERLY, AND INDIVIDUALS WITH SPECIAL HEALTH CARE NEEDS).

93.226 - Research on Healthcare Costs, Quality and Outcomes

Division of Grants Management [HHS - AHRQ]

Center for Evidence and Practice Improvement (CEPI) [HHS - AHRQ]

Memphis, Tennessee 38163 United States

Single Zip Code

Supporting Primary Care to Advance Cardiovascular Health in States with High Prevalence of Preventable CVD Events (U18) (RFA-HS-20-002)

Amendment Since initial award the End Date has been extended from 02/29/24 to 02/28/25 and the total obligations have increased 190% from $1,519,716 to $4,407,774.