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Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial

Peiris, David, Usherwood, Tim, Panaretto, Kathryn, Harris, Mark, Hunt, Jennifer, Redfern, Julie, Zwar, Nicholas, Colagiuri, Stephen, Hayman, Noel, Lo, Serigne, Patel, Bindu, Lyford, Marilyn, MacMahon, Stephen, Neal, Bruce, Sullivan, David, Cass, Alan, Jackson, Rod and Patel, Anushka (2015). Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial. Circulation: Cardiovascular Quality and Outcomes,8(1):87-95.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 6
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IRMA ID 75039815xPUB871
Title Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial
Author Peiris, David
Usherwood, Tim
Panaretto, Kathryn
Harris, Mark
Hunt, Jennifer
Redfern, Julie
Zwar, Nicholas
Colagiuri, Stephen
Hayman, Noel
Lo, Serigne
Patel, Bindu
Lyford, Marilyn
MacMahon, Stephen
Neal, Bruce
Sullivan, David
Cass, Alan
Jackson, Rod
Patel, Anushka
Journal Name Circulation: Cardiovascular Quality and Outcomes
Publication Date 2015
Volume Number 8
Issue Number 1
ISSN 1941-7713   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84927633912
Start Page 87
End Page 95
Total Pages 9
Place of Publication United States
Publisher Lippincott Williams & Wilkins
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited.

Methods and Results
Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥35 years and others aged ≥45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38 725 patients (mean age, 61.0 years; 42% men) was 17.5 months. Mean monthly staff support was <1 hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio; 1.25; 95% confidence interval, 1.04–1.50; P=0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10 308; 56.8% versus 51.2%; P=0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7%; P<0.001), lipid-lowering (19.2% versus 4.8%; P<0.001), and blood pressure–lowering medications (23.3% versus 12.1%; P=0.02).

Conclusions
In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management.

Keywords cardiovascular diseases
primary health care
quality improvement
DOI http://dx.doi.org/10.1161/CIRCOUTCOMES.114.001235   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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