# Adapting Guideline Implementation to Local Environments (AGILE) in Primary Care After Telehealth Expansion

> **NIH AHRQ K01** · UNIVERSITY OF WISCONSIN-MADISON · 2022 · $148,255

## Abstract

PROJECT SUMMARY / ABSTRACT
Urgent expansion of telehealth due to the COVID-19 pandemic may have consequences for evidence based
primary care, including worsening disparities in cardiovascular disease (CVD) prevention. Implementing
evidence based guidelines to reverse CVD risk would prevent more than 50% of annual deaths in middle-aged
US adults but is already uneven. Guideline adherence can be improved by tailoring strategies to local barriers
as in Dr. Ramly’s prior work that increased follow up on blood pressure and smoking with higher gains among
Black patients. Yet tailoring is too expensive and burdensome to be used in practice and is even less feasible
with the rapid telehealth expansion. There is a critical need for an alternative to tailoring to enable primary care
clinics to rapidly adapt how they implement CVD guidelines after telehealth expansion to avoid worsening
disparities. In engineering, configurable solutions make menus of options available to avoid expensive
individual tailoring. This approach could enable clinics to use known strategies to address local barriers without
engaging in an expert-led individual tailoring process. Preliminary qualitative work found many barriers to
optimal care with telehealth that are modifiable with known strategies. Yet configurable solutions using known
strategies have not been applied in health care despite the potential to reduce cost and reduce disparities by
addressing local needs. Applying this approach will require multi-stakeholder design of a configurable toolkit
informed by large clinical data and tested by a pragmatic clinical trial. Dr. Ramly’s long-term goal is to become
a clinical investigator in primary care leading an independent research program to improve rapid
implementation of evidence based care for chronic conditions. This 5-year K01 will fill his clinical investigation
training gaps with mentored research and training in large clinical data, mixed methods, and pragmatic clinical
trials. As a systems engineer faculty in a clinical department, Dr. Ramly is well prepared for a successful K01
to transition from engineer collaborator to independent clinical investigator. The overall objective of this
proposal is to develop and pilot a configurable toolkit for CVD prevention. Four CVD quality metrics will be
targeted: blood pressure control for patients with hypertension, and aspirin, statins, and smoking cessation for
patients with coronary artery disease. The specific aims are to: 1) characterize barriers to implementation of
CVD guidelines in primary care after telehealth expansion, 2) develop a configurable toolkit of strategies to
address local barriers, and 3) pilot test the toolkit to assess reach, effectiveness, adoption, implementation,
and maintenance, including subgroup differences. Expected outcomes are an intervention addressing a critical
gap in evidence based care after telehealth expansion, with preliminary data for an AHRQ R18 trial. Dr. Ramly
will become an inde...

## Key facts

- **NIH application ID:** 10429331
- **Project number:** 1K01HS028926-01
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Edmond Ramly
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $148,255
- **Award type:** 1
- **Project period:** 2022-04-08 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10429331

## Citation

> US National Institutes of Health, RePORTER application 10429331, Adapting Guideline Implementation to Local Environments (AGILE) in Primary Care After Telehealth Expansion (1K01HS028926-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10429331. Licensed CC0.

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