TEACH-ASCVD Program Overview

Last Updated: Thursday, 09-Feb-2023 15:15:00 EST

 

 

LEVERAGING IMPLEMENTATION SCIENCE 

The National Lipid Association (NLA) Health Quality and Research (HQR) committee is hoping to bring forward a system-based intervention for physicians, physician assistants, and nurse practitioners working in cardiology and internal medicine to provide practical and implementable solutions for the care of high and very-high risk patients. Primary Objective: Study how best to implement changes to practice at the system level. 

 

TARGET AUDIENCE 

The NLA will target areas of the country with a high probability of undiagnosed FH cases and/or the highest CVD mortality rates. Our target participants are those in the participating health systems who are charged with managing lipids in adults and/or adult patients with acute coronary syndrome. 

Our focus is very-high risk secondary prevention patients such as those with a recent myocardial infarction, and high-risk primary prevention patients such as those with Heterozygous Familial Hypercholesterolemia (HeFH) and Homozygous Familial Hypercholesterolemia (HoFH), and other independent risk factors such as elevated Lipoprotein(a).

 

EDUCATIONAL FOCUS 

Familial Hypercholesterolemia

  • Differences between HoFH and HeFH o Phenotypic FH
  • Management of HoFH*
  • Management of HeFH and patients with severe hypercholesterolemia
  • Recognition of secondary causes of severe hypercholesterolemia, including elevated Lp(a)

Care of patients post-Myocardial Infarction (MI) 

  • Internists have collaborative roles with cardiologists of post-MI patients, especially in managing the family.

Team-based approaches to care 

  • Referrals, the role of the Lipid Specialist, and the role of the genetic counselor

 

Participants will take within a 30-day time frame:

  • Seven online educational modules: Virtual clinic Decision Consequence Simulations
    • Four 10-minute modules covering the diagnosis and management of four patients 
      • Patient case highlighting phenotypic FH
      • Patient case highlighting HeFH
      • Patient case highlighting HoFH
      • Patient case highlighting elevated Lp(a)
    • Three 10-minute modules covering systematic care of patients after a Myocardial Infarction
      • Patient case highlighting Post-MI management strategies
      • Patient case highlighting the role of the healthcare team working in cardiology
      • Patient case highlighting the role of the healthcare team working in internal medicine
    • Self-Assessment Program on the 2018 Guideline on the Management of Blood Cholesterol
      • All participants, even those in the Control Groups, will have access to the complete SAP after their participation concludes.
    • 15-minute team huddles led by the department chief/site champion to present educational slide decks
    • Digital toolkit inclusive of patient-in-clinic counseling tools

EDUCATIONAL INTERVENTION DELIVERY

Our e-learning modules will leverage DecisionSim™, an interactive, cloud-based simulation platform, designed to enhance and assess clinical decision-making. All participant’s activity data will be collected for analysis and reporting.

These simulations replicate the complex challenges clinicians working in healthcare systems face daily. Grounded in adult learning theory and providing rich feedback and data, Decision Sim helps ensure the transfer of decision-making skills to a constantly evolving clinical environment, improving the delivery of healthcare. Decision Simis a highly effective, engaging, and adaptable branched narrative simulation platform that: Enhances and assesses clinical decision-making skills, a key factor in ensuring enduring change in clinical practice. Improves knowledge and retention by allowing clinicians to utilize simulations that are based on their patient population and within an environment that is as similar as possible to the one in which they will be making their clinical practice decisions. accelerates the development of expertise and competency by leveraging modern educational models such as deliberate practice, conscious reflection, and personalized feedback.

 

ASSESSMENT – QUANTITATIVE CLINICAL REVIEW

We will partner with our participating sites to collect EHR data* to analyze several clinical metrics.

In closed healthcare systems we will conduct sub-analyses utilizing health plan/insurance claim data

The aim is to report on insurance benefit design and the impact on lipid control (Ex. High deductible health plans versus Medicare versus standard insurance)

Metrics:

 o Site/population demographics

 o How many people in the system are on guideline-recommended therapy

 o How many FH diagnoses have been made o % of ordered prescriptions (and filled prescriptions in the event that     we have access to health plan data in closed healthcare systems)

 o # of lipid panels ordered

We will also conduct a comparative analysis of telehealth visits versus in-person to assess the impact on lipid control.

SITE RECRUITMENT & ENTRANCE CRITERIA

The NLA will recruit health systems of comparable sizes and structure across all 4 regions in the United States. We will aim to recruit 5 sites per region for 20 sites total. There will be an estimated 60 participants within each site with a participant group of (≥ 30 participants) for an estimated 1,200*total participants observed over the project timeline.

The NLA is aiming for enrollment groups within each site to contain 20-50%participants working in cardiology. We will identify 1 group leader (site champion) within each group at every enrolled site to ensure that the interventions address their system’s unique needs and structure/barriers, and to encourage continual participation among their group’s-clinician participants. If a site of interest doesn’t meet the entrance criteria, they can still enroll as a group participant and the NLA will forego the inter-system comparative analysis.

As defined by the U.S. Census Bureau* ≥400 study participants are needed for statistical significance at a 95% CI with a 5% margin of error.

As defined by the U.S. Census Bureau

 

If interested, please sign up using this link:
https://forms.office.com/r/MM76BL0i5M

 

Funding Statement: This program is sponsored by Amgen Inc. This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc.