Reducing cardiovascular disease risk in diabetes: A randomised controlled trial of a quality improvement initiative

Santhi Chalasani, David P. Peiris, Tim Usherwood, Julie Redfern, Bruce C. Neal, David R. Sullivan, Stephen Colagiuri, Nicholas A. Zwar, Qiang Li, Anushka Patel

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Abstract

Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes. Research design and methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial. Setting and participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months. Intervention: Quality improvement initiative comprising pointof- care electronic decision support with audit and feedback tools. Main outcome measures: Adherence to CVD risk screening and prescribing guidelines. Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28). Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence–practice gaps.

Original languageEnglish
Pages (from-to)436-441
Number of pages6
JournalMedical Journal of Australia
Volume206
Issue number10
DOIs
Publication statusPublished - 5 Jun 2017
Externally publishedYes

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Quality Improvement
Cardiovascular Diseases
Randomized Controlled Trials
Guidelines
Risk Management
Disease Management
LDL Cholesterol
Health Services
Primary Health Care
Research Design
Outcome Assessment (Health Care)
Blood Pressure
Therapeutics

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Chalasani, S., Peiris, D. P., Usherwood, T., Redfern, J., Neal, B. C., Sullivan, D. R., ... Patel, A. (2017). Reducing cardiovascular disease risk in diabetes: A randomised controlled trial of a quality improvement initiative. Medical Journal of Australia, 206(10), 436-441. https://doi.org/10.5694/mja16.00332
Chalasani, Santhi ; Peiris, David P. ; Usherwood, Tim ; Redfern, Julie ; Neal, Bruce C. ; Sullivan, David R. ; Colagiuri, Stephen ; Zwar, Nicholas A. ; Li, Qiang ; Patel, Anushka. / Reducing cardiovascular disease risk in diabetes : A randomised controlled trial of a quality improvement initiative. In: Medical Journal of Australia. 2017 ; Vol. 206, No. 10. pp. 436-441.
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abstract = "Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes. Research design and methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial. Setting and participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months. Intervention: Quality improvement initiative comprising pointof- care electronic decision support with audit and feedback tools. Main outcome measures: Adherence to CVD risk screening and prescribing guidelines. Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0{\%} v 39.5{\%}; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5{\%} v 39.6{\%}; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28{\%}, 44{\%} and 24{\%} respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28). Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence–practice gaps.",
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Chalasani, S, Peiris, DP, Usherwood, T, Redfern, J, Neal, BC, Sullivan, DR, Colagiuri, S, Zwar, NA, Li, Q & Patel, A 2017, 'Reducing cardiovascular disease risk in diabetes: A randomised controlled trial of a quality improvement initiative' Medical Journal of Australia, vol. 206, no. 10, pp. 436-441. https://doi.org/10.5694/mja16.00332

Reducing cardiovascular disease risk in diabetes : A randomised controlled trial of a quality improvement initiative. / Chalasani, Santhi; Peiris, David P.; Usherwood, Tim; Redfern, Julie; Neal, Bruce C.; Sullivan, David R.; Colagiuri, Stephen; Zwar, Nicholas A.; Li, Qiang; Patel, Anushka.

In: Medical Journal of Australia, Vol. 206, No. 10, 05.06.2017, p. 436-441.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Reducing cardiovascular disease risk in diabetes

T2 - A randomised controlled trial of a quality improvement initiative

AU - Chalasani, Santhi

AU - Peiris, David P.

AU - Usherwood, Tim

AU - Redfern, Julie

AU - Neal, Bruce C.

AU - Sullivan, David R.

AU - Colagiuri, Stephen

AU - Zwar, Nicholas A.

AU - Li, Qiang

AU - Patel, Anushka

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Y1 - 2017/6/5

N2 - Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes. Research design and methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial. Setting and participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months. Intervention: Quality improvement initiative comprising pointof- care electronic decision support with audit and feedback tools. Main outcome measures: Adherence to CVD risk screening and prescribing guidelines. Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28). Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence–practice gaps.

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