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

David Peiris, Tim Usherwood, Kathryn Panaretto, Mark Harris, Jennifer Hunt, Julie Redfern, Nicholas Zwar, Stephen Colagiuri, Noel Hayman, Serigne Lo, Bindu Patel, Marilyn Lyford, Stephen Macmahon, Bruce Neal, David Sullivan, Alan Cass, Rod Jackson, Anushka Patel

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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=10308; 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 highrisk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. Clinical Trial Registration: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910.

Original languageEnglish
Pages (from-to)87-95
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number1
DOIs
Publication statusPublished - 1 Jan 2015
Externally publishedYes

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Risk Management
Disease Management
Quality Improvement
Primary Health Care
Cardiovascular Diseases
Prescriptions
Clinical Trials
Guidelines
Therapeutics
New Zealand
Cluster Analysis
Registries
Software
Randomized Controlled Trials
Odds Ratio
Confidence Intervals
Blood Pressure
Delivery of Health Care
Lipids

Cite this

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. / 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. In: Circulation: Cardiovascular Quality and Outcomes. 2015 ; Vol. 8, No. 1. pp. 87-95.
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Peiris, D, Usherwood, T, Panaretto, K, Harris, M, Hunt, J, Redfern, J, Zwar, N, Colagiuri, S, Hayman, N, Lo, S, Patel, B, Lyford, M, Macmahon, S, Neal, B, Sullivan, D, Cass, A, Jackson, R & Patel, A 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, vol. 8, no. 1, pp. 87-95. https://doi.org/10.1161/CIRCOUTCOMES.114.001235

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; Patel, Anushka.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 1, 01.01.2015, p. 87-95.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care

T2 - The treatment of cardiovascular risk using electronic decision support cluster-randomized trial

AU - Peiris, David

AU - Usherwood, Tim

AU - Panaretto, Kathryn

AU - Harris, Mark

AU - Hunt, Jennifer

AU - Redfern, Julie

AU - Zwar, Nicholas

AU - Colagiuri, Stephen

AU - Hayman, Noel

AU - Lo, Serigne

AU - Patel, Bindu

AU - Lyford, Marilyn

AU - Macmahon, Stephen

AU - Neal, Bruce

AU - Sullivan, David

AU - Cass, Alan

AU - Jackson, Rod

AU - Patel, Anushka

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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=10308; 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 highrisk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. Clinical Trial Registration: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910.

AB - 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=10308; 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 highrisk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. Clinical Trial Registration: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910.

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