Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data

Catherine Deri Armstrong, Monica Taljaard, William Hogg, Amy E Mark, Clare Liddy, Catherine Deri Armstrong, Monica Taljaard, William Hogg, Amy E Mark, Clare Liddy

Abstract

Background: Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC's effect on CVD-related hospitalizations.

Methods: IDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC's effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness.

Results: Our sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses.

Conclusions: Clinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score analysis were neither due to choice of outcome nor relatively short follow-up period.

Trial registration: ClinicalTrials.gov NCT00574808 , registered on 14 December 2007.

Keywords: Cardiovascular health; Practice facilitation; Primary care.

Figures

Fig. 1
Fig. 1
The Improved Delivery of Cardiovascular Care (IDOCC) stepped wedge study design used in the analysis of clinical outcomes using population-based health administrative data. Legend: the darker nonstriped cells indicate IDOCC intervention years and the striped cells indicate post-IDOCC years where patients may still be benefitting from the intervention. Blank cells represent control periods
Fig. 2
Fig. 2
Observed cardiovascular disease (CVD) hospitalization rates among all patients with, or at risk of, CVD

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Source: PubMed

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