澳大利亚初级卫生保健中持续使用多方面计算机化质量改进干预措施对心血管疾病管理的影响。

Impact of Sustained Use of a Multifaceted Computerized Quality Improvement Intervention for Cardiovascular Disease Management in Australian Primary Health Care.

机构信息

The George Institute for Global Health, University of Sydney, Camperdown, Australia

The George Institute for Global Health, University of Sydney, Camperdown, Australia.

出版信息

J Am Heart Assoc. 2017 Oct 24;6(10):e007093. doi: 10.1161/JAHA.117.007093.

BACKGROUND

We evaluated a multifaceted, computerized quality improvement intervention for management of cardiovascular disease (CVD) risk in Australian primary health care. After completion of a cluster randomized controlled trial, the intervention was made available to both trial arms. Our objective was to assess intervention outcomes in the post-trial period and any heterogeneity based on original intervention allocation.

METHODS AND RESULTS

Data from 41 health services were analyzed. Outcomes were (1) proportion of eligible population with guideline-recommended CVD risk factor measurements; and (2) the proportion at high CVD risk with current prescriptions for guideline-recommended medications. Patient-level analyses were conducted using generalized estimating equations to account for clustering and time effects and tests for heterogeneity were conducted to assess impact of original treatment allocation. Median follow-up for 22 809 patients (mean age, 64.2 years; 42.5% men, 26.5% high CVD risk) was 17.9 months post-trial and 35 months since trial inception. At the end of the post-trial period there was no change in CVD risk factor screening overall when compared with the end of the trial period (64.7% versus 63.5%, =0.17). For patients at high CVD risk, there were significant improvements in recommended prescriptions at end of the post-trial period when compared with the end of the trial period (65.2% versus 56.0%, <0.001). There was no heterogeneity of treatment effects on the outcomes based on original randomization allocation.

CONCLUSIONS

CVD risk screening improvements were not observed in the post-trial period. Conversely, improvements in prescribing continued, suggesting that changes in provider and patient actions may take time when initiating medications.

CLINICAL TRIAL REGISTRATION

URL: http://www.anzctr.org.au. Unique identifier: 12611000478910.

背景

我们评估了一种多方面的、计算机化的质量改进干预措施，以管理澳大利亚初级医疗保健中的心血管疾病（CVD）风险。在完成一项集群随机对照试验后，该干预措施可供试验组使用。我们的目的是评估试验后期间的干预结果，以及基于原始干预分配的任何异质性。

方法和结果

分析了 41 个卫生服务的数据。结果为：（1）符合指南建议的 CVD 危险因素测量标准的合格人群比例；（2）目前有指南推荐药物处方的高危 CVD 人群比例。使用广义估计方程对患者水平进行分析，以考虑聚类和时间效应，并进行异质性检验，以评估原始治疗分配的影响。对 22809 名患者（平均年龄 64.2 岁；男性 42.5%，高危 CVD 26.5%）进行了中位随访 17.9 个月（试验结束后）和 35 个月（试验开始后）。与试验结束时相比，在试验结束后期间，CVD 危险因素筛查总体上没有变化（64.7%比 63.5%，=0.17）。对于高危 CVD 的患者，与试验结束时相比，试验结束后推荐处方有显著改善（65.2%比 56.0%，<0.001）。基于原始随机分组分配，治疗效果没有异质性。