Secondary outcomes

Secondary outcomes include implementers’ perceptions of the acceptability, appropriateness, and feasibility of the CUSP implementation strategy; client receipt of evidence-based care for hypertension, dyslipidemia, and diabetes mellitus; and client hypertension, dyslipidemia, and diabetes mellitus control. We will measure the change in these outcomes from baseline to 6 and 12 months.

Acceptability, appropriateness, and feasibility will be measured using three validated survey measures: the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Each of these measures includes four items measured on a 5-point Likert scale. An average score for each measure is calculated by summing responses across all four items and dividing by the total number of items. A higher score signifies greater acceptability, appropriateness, or feasibility. These survey measures will be completed by all CUSP team members.

Measures of client receipt of evidence-based cardiovascular risk factor care will include the percent of eligible consumers who receive each of the following evidence-based care practices: percentage of clients with SMI with poorly controlled hypertension (see definition below) who had a follow-up blood pressure measurement within 3 months; percentage of clients with SMI diagnosed with diabetes mellitus who received each of the following in the past 12 months: a lipid panel, statin therapy, a dilated eye exam, a foot exam, and a urine-protein-creatinine test; percentage of clients with SMI diagnosed with diabetes mellitus who had a HbA1c measurement in the past 6 months; and percentage of clients with SMI diagnosed with dyslipidemia who received a lipid panel in the past 12 months. We will also measure the percentage of clients with SMI diagnosed with each of the three cardiovascular risk factors of interest who received diet and exercise counseling.

Measures of cardiovascular risk factor control will include the percentage of clients with SMI diagnosed with hypertension who have controlled hypertension, defined as blood pressure < 130/80 mmHg; percentage of clients with SMI diagnosed with dyslipidemia who have controlled dyslipidemia, defined as low-density lipoprotein total cholesterol < 200 mg/dl and LDL < 130 mg/dl (primary measure) or on a statin (secondary measure); and the percentage of clients with SMI diagnosed with diabetes mellitus with controlled diabetes, defined as HbA1c < 7.0.