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

Authors

David Peiris, University of SydneyFollow
Tim Usherwood, University of Sydney
Kathryn S. Panaretto, University of Sydney, University of NewcastleFollow
M G. Harris, University of Sydney
Jennifer Hunt, University of Sydney, Aboriginal Health & Medical Research Council of New South Wales
Julie Redfern, University of Sydney
Nicholas Arnold Zwar, University of WollongongFollow
Stephen Colagiuri, University of Sydney
Noel Hayman, University of Sydney
Serigne Lo, University of Sydney
Bindu Patel, University of Sydney
Marilyn Lyford, University of SydneyFollow
Stephen MacMahon, University of Sydney
Bruce Neal, University of Sydney, George Institute for International HealthFollow
David R. Sullivan, Royal Prince Alfred Hospital
Alan Cass, University of Sydney, The George Institute For Global Health, Menzies School Of Health ResearchFollow
Rod Jackson, University of Sydney
Anushka Dr Anushka Patel, University of Sydney

RIS ID

111775

Publication Details

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, 8 (1), 87-95.

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.