JMIR Publications

ABSTRACT

Background:

Clinical practice guidelines recommend antiplatelet and statin therapies, as well as blood pressure control and tobacco cessation for secondary prevention in patients with established atherosclerotic cardiovascular diseases (ASCVDs). However, these strategies for risk modification are underused especially in rural communities. Moreover, resources to support delivery of preventive care to rural patients are less than their urban counterparts. Transformative interventions for delivery of tailored preventive cardiovascular care to rural patients are needed.

Objective:

A multidisciplinary team developed a rural-specific, team-based care intervention assisted by clinical decision support (CDS) technology using participatory design in a sociotechnical conceptual framework. The intervention included redesigned workflows and a novel CDS technology for coordination and delivery of guideline recommendations by primary care teams in a rural clinic.

Methods:

Intervention design was comprised of three phases: (I) problem identification, (II) experimentation and (III) testing. Input from team members (n=35) required 150 hours, including observations of clinical encounters, provider workshops and interviews of patients and health care professionals. The intervention was prototyped, iteratively refined, and tested with user feedback. In a three-month pilot trial, 369 ASCVD patients were randomized to control or intervention arms.

Results:

New workflows and a novel CDS tool were created to identify ASCVD patients with gaps in preventive care and assign the right care team member for delivery of tailored recommendations. During the pilot the intervention prototype was iteratively refined and tested. The pilot demonstrated feasibility for successful implementation of the sociotechnical intervention as the proportion of patients who had encounters with advance practice providers (nurse practitioners/physician assistants), pharmacists, or tobacco cessation coaches for delivery of guideline recommendations in the intervention arm was greater compared to the control arm.

Conclusions:

Participatory design and a sociotechnical conceptual framework enabled development of a rural-specific, team-based care intervention assisted by CDS technology for transformation of preventive health care delivery for ASCVDs.