Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care

A Practice-randomized, Comparative Effectiveness Trial

Bibliographic Data

ID9099042
AuthorsStephen D Persell (0000-0003-2462-1314, Department of Medicine, Division of General Internal Medicine and Geriatrics, corresponding author), David T Liss (0000-0001-5505-2922, Department of Medicine, Division of General Internal Medicine and Geriatrics, corresponding author), Theresa L Walunas (0000-0002-7653-3650, Department of Medicine, Division of General Internal Medicine and Geriatrics, corresponding author), Jody D Ciolino (0000-0002-9060-5657, Department of Preventive Medicine, Division of Biostatistics), Faraz S Ahmad (0000-0002-2613-2541, Center for Health Information Partnerships, Institute for Public Health and Medicine), Tiffany Brown (Department of Medicine, Division of General Internal Medicine and Geriatrics, corresponding author), Dustin D French (0000-0003-4064-3206, Department of Ophthalmology, corresponding author), Randy Hountz (Purdue Healthcare Advisors, West Lafayette, IN), Karen Iversen (AllianceChicago), Stacy Tessler Lindau (0000-0002-9054-6538, University of Chicago), Dawid Lipiszko (0000-0001-9688-9585, Department of Medicine, Division of General Internal Medicine and Geriatrics, corresponding author), Jennifer A Makelarski (0000-0001-6484-1675, Obstetrics and Gynecology, University of Chicago, Chicago), Kathryn Mazurek (0000-0002-8350-1753, Northern Illinois University), Linda Murakami (0000-0002-3021-9818, American Medical Association, Chicago, corresponding author), Yaw Peprah (0000-0001-7211-9519, Department of Medicine, Division of General Internal Medicine and Geriatrics, corresponding author), Jennifer Potempa (Telligen, Oak Brook, IL), Luke V Rasmussen (0000-0002-4497-8049, Department of Preventive Medicine, Division of Health and Biomedical Informatics), Andrew Wang (0000-0001-8729-0933, Institute of Public Health Zadar, corresponding author), Andrew L Wang (0000-0003-4016-9460, Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine), Jesi Wang (MetaStar; Madison, WI), Chen Yeh (0000-0003-1320-3870, Department of Preventive Medicine, Division of Biostatistics), Abel N Kho (Department of Medicine, Division of General Internal Medicine and Geriatrics), Abel Kho (0000-0003-1993-5634, General Department of Preventive Medicine, corresponding author)
Year2020
Volume58
Issue4
Pages344-351
Publication date2020-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001260
PMID31876643
OpenAlexW2997172882
LanguageEN
References cited19

BACKGROUND: Effective quality improvement (QI) strategies are needed for small practices. 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. DESIGN: Two arm, practice-randomized, comparative effectiveness study. PARTICIPANTS: Small and mid-sized primary care practices. INTERVENTIONS: Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies. 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. 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 0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09-0.51) but did not significantly differ across arms. CONCLUSION: Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone

Aspirin · Blood pressure · Clinical endpoint · Confidence interval · Environmental health · Facilitation · Physical therapy · Population · Psychological intervention · Randomized controlled trial · Smoking cessation · Health Policy Implementation Science · Health Promotion and Cardiovascular Prevention · Internal Medicine · Medicine · Nursing · Primary Care and Health Outcomes

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