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Familial HypercholesterolemiaCARE-FHNCT05284513

Collaborative Approach to Reach Everyone With Familial Hypercholesterolemia (CARE-FH)

A study testing FH diagnosis program, Implementation strategy package: Develop and implement tools for quality monitoring and Implementation strategy package: Develop educational materials in people with Familial Hypercholesterolemia, run by Geisinger Clinic at 1 site in United States.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

Diagnosis rates of familial hypercholesterolemia (FH) are low in the United States, despite multiple guidelines and recommendations for screening and treatment of high cholesterol, to prevent heart attacks in those affected. Read more about this study

Who is it for?
Ages 26 years and older
Conditions the study is for
Familial Hypercholesterolemia
What is being tested?
FH diagnosis program, Implementation strategy package: Develop and implement tools for quality monitoring and Implementation strategy package: Develop educational materials
Could I receive a placebo?
No, everyone receives an active treatment
How many people
532 participants
Where
1 siteUnited States
Study dates
9 Sep 2022to Jan 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 26 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Primary care clinicians (pediatrician, community medicine, internal medicine) in the Geisinger Healthcare System

Who cannot join

  • None

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site
  • Geisinger Clinic

    Multiple Locations, Pennsylvania, 00000

Other trials in United States

About this study

Diagnosis rates of familial hypercholesterolemia (FH) are low in the United States, despite multiple guidelines and recommendations for screening and treatment of high cholesterol, to prevent heart attacks in those affected. Using a stepped-wedge design, the investigators plan to utilize tools from implementation science to improve uptake, acceptability, and sustainability of FH diagnostic programs in primary care settings. If successful, this study will provide tools generalizable to other health care systems to improve FH diagnosis rates.

Read the detailed description

Familial hypercholesterolemia (FH) is a common genetic disorder (prevalence 1 in 250) that requires lifelong sustained medical care. Evidence-based guidelines for screening and treatment for FH exist. These include universal screening of children ages 9-11, of adolescents ages 18-20, and of adults ages 40 and above; approved diagnostic tools including lipid panels and genetic testing; and recommendations for initiation of lipid lowering medication. FH diagnosis is currently made too late in life, often after a premature heart attack has occurred creating a care gap that results in excess cardiovascular morbidity and mortality. Diagnosing FH in the primary care setting would optimize treatment for individuals with FH and close this care gap. Utilizing tools from implementation science and human centered design, and by considering uptake, acceptability, and sustainability of programs related to FH care should improve earlier diagnosis. Implementation strategies that include insights from patients, clinicians, and healthcare systems are necessary. The long-term goal is to create an effective FH diagnosis program that is practical and sustainable in the real-world setting. The main objective of this project is to determine the uptake of an FH diagnosis program integrated into primary care practices to promote early identification of adult and pediatric patients that is generalizable to other healthcare settings. The research question is, does using a multi-level implementation strategy package, designed to address the specific needs of patients, clinicians, and healthcare systems, improve the diagnosis and activation of care management for individuals with FH. The specific aims are to: 1) to design a clinical trial to assess multi-level implementation strategies for improving FH diagnosis in an integrated health system, 2) compare FH diagnosis rates among primary care clinicians who receive the implementation strategy package versus those who do not, 3) to measure implementation success of an organized FH diagnosis program, and 4) to explore patient-related service and health outcomes related to an FH diagnosis program.

Being tested
FH diagnosis program, Implementation strategy package: Develop and implement tools for quality monitoring, Implementation strategy package: Develop educational materials, Implementation strategy package: Conduct educational outreach visits, Implementation strategy package: Intervene with clinicians and patients to enhance
Medical subject headings
Hyperlipoproteinemia Type II

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • FH diagnosis programBehavioural

    Uptake of screening, diagnosis, and initiation of care management for FH

  • Implementation strategy package: Develop and implement tools for quality monitoringBehavioural

    EHR tools to order labs, record results, and document FH care

  • Implementation strategy package: Develop educational materialsBehavioural

    Education regarding guidelines for identification and treatment of FH

  • Implementation strategy package: Conduct educational outreach visitsBehavioural

    Continuing medical education (CME) material for FH that is presented to

  • Implementation strategy package: Intervene with clinicians and patients to enhanceBehavioural

    Notify patients simultaneously with clinicians about the need for screening

  • Behavioral (e.g., Psychotherapy, Lifestyle Counseling) Implementation strategy package: Identify and prepare champions Clinical lipid championsBehavioural

    Clinical lipid champions

  • Implementation strategy package: Audit and provide feedbackBehavioural

    Provide aggregate level feedback to clinics on diagnosing FH

  • Implementation strategy package: Stage implementation scale upBehavioural

    Develop the timeline for the stepped-wedge rollout to primary care

Study groups in NCT05284513
Study groupRoleWhat they receive
Phase 1OtherPhased rollout to clinic sites across the the Geisinger system using stepped wedge design
Receives: Behavioral: FH diagnosis program; Behavioral: Implementation strategy package: Develop and implement tools for quality monitoring; Behavioral: Implementation strategy package: Develop educational materials; Behavioral: Implementation strategy package: Conduct educational outreach visits; Behavioral: Implementation strategy package: Intervene with clinicians and patients to enhance; Behavioral: Behavioral (e.g., Psychotherapy, Lifestyle Counseling) Implementation strategy package: Identify and prepare champions Clinical lipid champions; Behavioral: Implementation strategy package: Audit and provide feedback; Behavioral: Implementation strategy package: Stage implementation scale up
Phase 2OtherPhased rollout to clinic sites across the the Geisinger system using stepped wedge design
Receives: Behavioral: FH diagnosis program; Behavioral: Implementation strategy package: Develop and implement tools for quality monitoring; Behavioral: Implementation strategy package: Develop educational materials; Behavioral: Implementation strategy package: Conduct educational outreach visits; Behavioral: Implementation strategy package: Intervene with clinicians and patients to enhance; Behavioral: Behavioral (e.g., Psychotherapy, Lifestyle Counseling) Implementation strategy package: Identify and prepare champions Clinical lipid champions; Behavioral: Implementation strategy package: Audit and provide feedback; Behavioral: Implementation strategy package: Stage implementation scale up
Phase 3OtherPhased rollout to clinic sites across the the Geisinger system using stepped wedge design
Receives: Behavioral: FH diagnosis program; Behavioral: Implementation strategy package: Develop and implement tools for quality monitoring; Behavioral: Implementation strategy package: Develop educational materials; Behavioral: Implementation strategy package: Conduct educational outreach visits; Behavioral: Implementation strategy package: Intervene with clinicians and patients to enhance; Behavioral: Behavioral (e.g., Psychotherapy, Lifestyle Counseling) Implementation strategy package: Identify and prepare champions Clinical lipid champions; Behavioral: Implementation strategy package: Audit and provide feedback; Behavioral: Implementation strategy package: Stage implementation scale up
Phase 4OtherPhased rollout to clinic sites across the the Geisinger system using stepped wedge design
Receives: Behavioral: FH diagnosis program; Behavioral: Implementation strategy package: Develop and implement tools for quality monitoring; Behavioral: Implementation strategy package: Develop educational materials; Behavioral: Implementation strategy package: Conduct educational outreach visits; Behavioral: Implementation strategy package: Intervene with clinicians and patients to enhance; Behavioral: Behavioral (e.g., Psychotherapy, Lifestyle Counseling) Implementation strategy package: Identify and prepare champions Clinical lipid champions; Behavioral: Implementation strategy package: Audit and provide feedback; Behavioral: Implementation strategy package: Stage implementation scale up
Phase 5OtherPhased rollout to clinic sites across the the Geisinger system using stepped wedge design
Receives: Behavioral: FH diagnosis program; Behavioral: Implementation strategy package: Develop and implement tools for quality monitoring; Behavioral: Implementation strategy package: Develop educational materials; Behavioral: Implementation strategy package: Conduct educational outreach visits; Behavioral: Implementation strategy package: Intervene with clinicians and patients to enhance; Behavioral: Behavioral (e.g., Psychotherapy, Lifestyle Counseling) Implementation strategy package: Identify and prepare champions Clinical lipid champions; Behavioral: Implementation strategy package: Audit and provide feedback; Behavioral: Implementation strategy package: Stage implementation scale up

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. FH diagnosis rate (Aim 2)

    FH diagnosis rate, is achieving both the scheduling of a clinic visit and evidence the clinician, at that visit, has completed evidence-based FH diagnostic evaluation, defined as completing one of: using the FH clinic note to document care, adding FH diagnosis on the problem list, using the FH smart-set (or ordered a genetic test for FH), making a referral to the lipid clinic, or starting a statin for an evidence-based indication

    Measured: Up to 45 months

  2. Acceptability (Aim 3)

    Clinician and patient satisfaction and self-efficacy with the FH diagnosis program

    Measured: Month 9, 12, 18, 24, 30, 36, 42

  3. Timeliness (Aim 4)

    Time to FH screen, time to diagnostic evaluation, time to statin initiation

    Measured: Up to 45 months

Secondary outcomes (12)
  1. Initiation medication use (Aim 2)

    Initiation of lipid lowering medication by healthcare clinician

    Measured: Up to 45 months

  2. Lipid measurement (Aim 2)

    Order of a lipid panel

    Measured: Up to 45 months

  3. Genetic testing (Aim 2)

    Order of a genetic test for FH

    Measured: Month 9, 12, 18, 24, 30, 36, 42

  4. Problem list diagnosis of FH (Aim 2)

    Clinician adds diagnosis of FH to the patients problem list in the electronic health record

    Measured: Up to 45 months

  5. FH smartset (Aim 2)

    Clinician uses and completes all field of the FH smartset

    Measured: Month 9, 12, 18, 24, 30, 36, 42

  6. Best Practice Alert (Aim 2)

    Clinician adheres to and acts on recommendation in the Best Practice Alert

    Measured: Up to 45 months

  7. FH Clinic Note (Aim 2)

    Clinician completes the FH clinic note

    Measured: Up to 45 months

  8. Fidelity (Aim 3)

    Documentation of adaptations to the FH diagnosis program

    Measured: Up to 45 months

  9. Cost (Aim 3)

    Cost to implement the implementation strategy package

    Measured: Up to 45 months

  10. Function (Aim 4)

    Return of genetic result to patient (if ordered and patient undergoes testing)

    Measured: Up to 45 months

  11. Function (Aim 4)

    Reduction in lipid level from baseline to end of the study period

    Measured: Up to 45 months

  12. Function (Aim 4)

    Patient side effects to medications

    Measured: Up to 45 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Mar 2022
  2. Study start9 Sep 2022
  3. Primary completionJan 2027 (estimated)
  4. Study completionJan 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Sequential
Model description
Stepped-wedge design
Masking
None (open label)
Enrolment
532 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05284513
Sponsor's protocol ID
2021-0927
Other IDs
1R61HL161775
Acronym
CARE-FH
Status last verified
Dec 2025
First submitted
18 Nov 2021
Last updated
22 Dec 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Available upon request from PIs

Publications

  • Jones LK, Romagnoli KM, Schubert TJ, Clegg K, Kirchner HL, Hu Y, Cawley D, Norelli V, Williams MS, Gidding SS, Rahm AK. Using implementation science to develop a familial hypercholesterolemia screening program in primary care: The CARE-FH study. J Clin Lipidol. 2024 Mar-Apr;18(2):e176-e188. doi: 10.1016/j.jacl.2024.01.001. Epub 2024 Jan 4.

    PubMed 38228467

Questions about this trial

What is this clinical trial studying?

A study testing FH diagnosis program, Implementation strategy package: Develop and implement tools for quality monitoring and Implementation strategy package: Develop educational materials in people with Familial Hypercholesterolemia, run by Geisinger Clinic at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: enrolling by invitation, as of the sponsor's last update on 22 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

FH diagnosis rate (Aim 2) (time frame: Up to 45 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05284513, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Dec 2025.

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