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 M 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

    Research output: Contribution to journalArticlepeer-review

    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.
    Original languageEnglish
    Pages (from-to)87-95
    Number of pages9
    JournalCirculation. Cardiovascular quality and outcomes
    Volume8
    Issue number1
    DOIs
    Publication statusPublished - 13 Jan 2015

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