Back to Search
Start Over
Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care: A Practice-randomized, Comparative Effectiveness Trial.
- Source :
-
Medical care [Med Care] 2020 Apr; Vol. 58 (4), pp. 344-351. - Publication Year :
- 2020
-
Abstract
- Background: Effective quality improvement (QI) strategies are needed for small practices.<br />Objective: The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care.<br />Design: Two arm, practice-randomized, comparative effectiveness study.<br />Participants: Small and mid-sized primary care practices.<br />Interventions: Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies.<br />Measures: Proportion of eligible patients in a practice meeting "ABCS" measures: (Aspirin) Aspirin/antiplatelet therapy for ischemic vascular disease, (Blood pressure) Controlling High Blood Pressure, (Cholesterol) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease, and (Smoking) Tobacco Use: Screening and Cessation Intervention, and the Change Process Capability Questionnaire. Measurements were performed at baseline, 12, and 18 months.<br />Results: A total of 226 practices were randomized, 179 contributed follow-up data. The mean proportion of patients meeting each performance measure was greater at 12 months compared with baseline: Aspirin 0.04 (95% confidence interval: 0.02-0.06), Blood pressure 0.04 (0.02-0.06), Cholesterol 0.05 (0.03-0.07), Smoking 0.05 (0.02-0.07); P<0.001 for each. Improvements were sustained at 18 months. At 12 months, baseline-adjusted difference-in-differences in proportions for the POC+PM arm versus POC was: Aspirin 0.02 (-0.02 to 0.05), Blood pressure -0.01 (-0.04 to 0.03), Cholesterol 0.03 (0.00-0.07), and Smoking 0.02 (-0.02 to 0.06); P>0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09-0.51) but did not significantly differ across arms.<br />Conclusion: Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
Details
- Language :
- English
- ISSN :
- 1537-1948
- Volume :
- 58
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Medical care
- Publication Type :
- Academic Journal
- Accession number :
- 31876643
- Full Text :
- https://doi.org/10.1097/MLR.0000000000001260