Impact of Patient Engagement on Treatment Decisions and Patient-Centered Outcomes in the Implementation of New Guidelines for the Treatment of Blood Cholesterol
GOALS Update members on recently submitted PCORI application Engage participants in planning PPRNet s approach to patient-centered and patient engaged research in implementation of cholesterol guidelines
PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE Independent, non-profit organization authorized under Affordable Care Act Fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions Funded >$200 million in research in 2013
PCORI PRIORITIES Research will help answer these questions: Given my personal characteristics, conditions and preferences, what should I expect will happen to me? What are my options and what are the potential benefits and harms of those options?
PCORI PRIORITIES Research will help answer these questions: What can I do to improve the outcomes that are most important to me? How can clinicians and the care delivery systems they work in help me make the best decisions about my health and healthcare?
PPRNET RESEARCH AND THE PCORI VISION Patient and stakeholder engagement Input on project design Identifying outcomes of interest Monitoring project progress Dissemination of results
PCORI: ASSESSMENT OF PREVENTION, DIAGNOSIS AND TREATMENT OPTIONS Comparative effectiveness research to: Inform critical decisions that face patients and caregivers, clinicians, policy makers, and health care system leaders Decisions occurring now in the absence of sound evidence about the comparative effectiveness of alternative approaches Substantial potential that patients/caregivers will benefit from the new knowledge in ways that are important to them
WHAT WE KNOW Cardiovascular disease remains a relevant problem Cholesterol is a key modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD)
WHAT WE KNOW American College of Cardiology/American Heart Association published revised guideline on the Treatment of Blood Cholesterol (TBC) in late 2013 Major shift in focus Emphasis on patientcentered approach Clinical controversies
WHAT WE KNOW 1 2 3 4 Statin Benefit Groups (SBGs) Patients with clinical ASCVD 21-75 years of age Patients with clinical ASCVD over 75 years of age Patients with primary elevations of LDL-C (greater than or equal to 190 mg/dl) Patients with diabetes, age 40-75 years with LDL-C 70-189 mg/dl, estimated 10-year ASCVD risk less than 7.5% Patients with diabetes, age 40-75 years with LDL-C 70-189 mg/dl, estimated 10-year ASCVD risk greater than or equal to 7.5% Patients with estimated 10-year ASCVD risk of at least 7.5% Statin Dose Recommendation High-intensity Moderate-intensity High-intensity Moderate-intensity High-intensity Patient-centered discussion prior to initiating moderate-tohigh intensity*
ASCVD Risk Reduction Practice-Level Report
ASCVD Risk Reduction PLR
WHAT WE DON T KNOW How to implement a patientcentered approach to discussion of treatment options in real world practice What types of practice-based interventions promote patientcentered decision making
A NEW APPROACH TO PPRNET PROJECTS Patient and stakeholder engagement Input on project design Identifying outcomes of interest Monitoring project progress Dissemination of results
CLINICIAN ENGAGEMENT Expressed interest across PPRNet activities Initial survey responses (39 in 10 days!) helped define research question Further input gathered during webinars and calls on what, how of intervention Invited patients to participate in survey
PATIENT INPUT What matters most to you? What it is in my situation that leads the doctor to make such a recommendation What should your doctor s role be in helping you make these decisions? Provide information I can use to self-educate I generally ask what the doctor would do in my situation I trust the advice of my doctor
PATIENT INPUT I lost my father to a massive coronary event at the age of 63 and my sister had a heart attack at 50. I had high cholesterol and with diet and medicine that is now under control. I think the key lies in within our power to prevent. Being a patient with diabetes that also receives treatment for high cholesterol this is something very near and dear to my heart.
AIMS OF THE PROPOSED PROJECT 1. Compare the impact of a patient-engaged, practice-based intervention to promote patient-centered care (PE-TRIP) to Usual PPRNet Implementation on concordance with the TBC guideline and patientreported outcomes among 30 PPRNet practices
AIMS OF THE PROPOSED PROJECT 2. Synthesize lessons learned during TBC guideline implementation to identify a set of strategies that promote concordance with the TBC guideline and patient-centered discussions of treatment options in primary care practice
PROJECT ACTIVITIES All practices: typical guideline implementation Introductory webinar on TBC guideline Quarterly reports Patient-engaged intervention practices + Site visits + Best practice meeting + webinars
PROJECT ACTIVITIES Patient surveys on patient-reported outcomes Focus groups among high performing practices Patient Partners to advise research team throughout project
CHANCES ARE We will not be funded We need your input on how to position our next wager!
ENGAGING CLINICIAN STAKEHOLDERS Recognizing the controversy of the new guidelines and their upcoming anniversary, is this engaging patients in implementation of new cholesterol guidelines the right topic for a PPRNet PCORI study? Why? Why not?
ENGAGING CLINICIAN STAKEHOLDERS This will be a Communication and Dissemination Research proposal. What gaps have you experienced in communicating new guideline recommendations to patients and their caregivers?
ENGAGING CLINICIAN STAKEHOLDERS What tools or strategies would help (or have helped) your practice engage patients in the implementation of the new guidelines?
ENGAGING CLINICIAN STAKEHOLDERS What PPRNet interventions would help your practice improve implementation of the new guideline?
WHAT NEXT? September 2014 October 2014 November 2014 Funding decisions Gather additional patient input Update practice letters of support Resubmission
SUMMARY We are committed to developing meaningful PCORI applications and look forward to your input! (See next presentation )