Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care

Authors: Sabine Ludt, Stephen M Campbell, Jan van Lieshout, Richard Grol, Joachim Szecsenyi, Michel Wensing

Published in: BMC Health Services Research | Issue 1/2011

Login to get access

Abstract

Background

Primary care can play an important role in providing cardiovascular risk management in patients with established Cardiovascular Diseases (CVD), patients with a known high risk of developing CVD, and potentially for individuals with a low risk of developing CVD, but who have unhealthy lifestyles. To describe and compare cardiovascular risk management, internationally valid quality indicators and standardized measures are needed. As part of a large project in 9 European countries (EPA-Cardio), we have developed and tested a set of standardized measures, linked to previously developed quality indicators.

Methods

A structured stepwise procedure was followed to develop measures. First, the research team allocated 106 validated quality indicators to one of the three target populations (established CVD, at high risk, at low risk) and to different data-collection methods (data abstraction from the medical records, a patient survey, an interview with lead practice GP/a practice survey). Secondly, we selected a number of other validated measures to enrich the assessment. A pilot study was performed to test the feasibility. Finally, we revised the measures based on the findings.

Results

The EPA-Cardio measures consisted of abstraction forms from the medical-records data of established Coronary Heart Disease (CHD)-patients - and high-risk groups, a patient questionnaire for each of the 3 groups, an interview questionnaire for the lead GP and a questionnaire for practice teams. The measures were feasible and accepted by general practices from different countries.

Conclusions

An internationally standardized measure of cardiovascular risk management, linked to validated quality indicators and tested for feasibility in general practice, is now available. Careful development and pilot testing of the measures are crucial in international studies of quality of healthcare.
Appendix
Available only for authorised users
Literature
1.
Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M: Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J. 2006, 27 (13): 1610-1619. 10.1093/eurheartj/ehi733.CrossRefPubMed
2.
Sheridan SL, Viera AJ, Krantz MJ, Ice CL, Steinman LE, Peters KE, et al: The effect of giving global coronary risk information to adults: a systematic review. Arch Intern Med. 2010, 170 (3): 230-239. 10.1001/archinternmed.2009.516.CrossRefPubMed
3.
Waldron CA, van der WT, Ludt S, Gallacher J, Elwyn G: What are effective strategies to communicate cardiovascular risk information to patients? A systematic review. Patient Educ Couns. 2010.
4.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al: European guidelines on cardiovascular disease prevention in clinical practice. Fourth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur J Cardiovasc Prev Rehabil. 2007, 14 (S2): S1-S113. 10.1097/01.hjr.0000277983.23934.c9.CrossRefPubMed
5.
Ferket BS, Colkesen EB, Visser JJ, Spronk S, Kraaijenhagen RA, Steyerberg EW, et al: Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check?. Arch Intern Med. 2010, 170 (1): 27-40. 10.1001/archinternmed.2009.434.CrossRefPubMed
6.
Van Lieshout J, Wensing M, Campbell SM, Grol R: Primary care strength linked to prevention programs for cardiovascular disease. Am J Manag Care. 2009, 15 (4): 255-262.PubMed
7.
D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al: General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study. Circulation. 2008, 117 (6): 743-753.CrossRefPubMed
8.
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al: Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003, 24 (11): 987-1003. 10.1016/S0195-668X(03)00114-3.CrossRefPubMed
9.
Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P: Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007, 335 (7611): 136-10.1136/bmj.39261.471806.55.CrossRefPubMedPubMedCentral
10.
Krones T, Keller H, Sonnichsen A, Sadowski EM, Baum E, Wegscheider K, et al: Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial. Ann Fam Med. 2008, 6 (3): 218-227. 10.1370/afm.854.CrossRefPubMedPubMedCentral
11.
van Steenkiste B, van der WT, Stoffers HE, Kester AD, Timmermans DR, Grol R: Improving cardiovascular risk management: a randomized, controlled trial on the effect of a decision support tool for patients and physicians. Eur J Cardiovasc Prev Rehabil. 2007, 14 (1): 44-50. 10.1097/01.hjr.0000239475.71805.1e.CrossRefPubMed
12.
Bonnevie L, Thomsen T, Jorgensen T: The use of computerized decision support systems in preventive cardiology--principal results from the national PRECARD survey in Denmark. Eur J Cardiovasc Prev Rehabil. 2005, 12 (1): 52-55. 10.1097/00149831-200502000-00008.PubMed
13.
Getz L, Kirkengen AL, Hetlevik I, Romundstad S, Sigurdsson JA: Ethical dilemmas arising from implementation of the European guidelines on cardiovascular disease prevention in clinical practice. Scandinavian Journal of Primary Health Care. 2004, 22 (4): 202-208. 10.1080/02813430410006693.CrossRefPubMed
14.
Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, et al: National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines. Circulation. 2005, 111 (4): 499-510. 10.1161/01.CIR.0000154568.43333.82.CrossRefPubMed
15.
Chauhan U: Cardiovascular disease prevention in primary care. Br Med Bull. 2007, ldm002
16.
Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U: Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. The Lancet. 2009, 373 (9667): 929-940. 10.1016/S0140-6736(09)60330-5.CrossRef
17.
WHO: World Health Report 2008. 2008, WHO, Geneva
18.
Starfield B, Shi L, Macinko J: Contribution of primary care to health systems and health. Milbank Q. 2005, 83 (3): 457-502. 10.1111/j.1468-0009.2005.00409.x.CrossRefPubMedPubMedCentral
19.
20.
Perera R, Dowell T, Crampton P, Kearns R: Panning for gold: an evidence-based tool for assessment of performance indicators in primary health care. Health Policy. 2007, 80 (2): 314-327. 10.1016/j.healthpol.2006.03.011.CrossRefPubMed
21.
Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M: Effects of pay for performance on the quality of primary care in England. N Engl J Med. 2009, 361 (4): 368-378. 10.1056/NEJMsa0807651.CrossRefPubMed
22.
Kirk SA, Campbell SM, Kennell-Webb S, Reeves D, Roland MO, Marshall MN: Assessing the quality of care of multiple conditions in general practice: practical and methodological problems. Qual Saf Health Care. 2003, 12 (6): 421-427. 10.1136/qhc.12.6.421.CrossRefPubMedPubMedCentral
23.
McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al: The quality of health care delivered to adults in the United States. N Engl J Med. 2003, 348 (26): 2635-2645. 10.1056/NEJMsa022615.CrossRefPubMed
24.
Campbell SM, Ludt S, Van Lieshout J, Boffin N, Wensing M, Petek D, et al: Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries. Eur J Cardiovasc Prev Rehabil. 2008, 15 (5): 509-515. 10.1097/HJR.0b013e328302f44d.CrossRefPubMed
25.
Guillemin F, Bombardier C, Beaton D: Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993, 46 (12): 1417-1432. 10.1016/0895-4356(93)90142-N.CrossRefPubMed
26.
Banks NJ: Designing medical record abstraction forms. Int J Qual Health Care. 1998, 10 (2): 163-167. 10.1093/intqhc/10.2.163.CrossRefPubMed
27.
Grol R, Wensing M, Mainz J, Jung HP, Ferreira P, Hearnshaw H, et al: Patients in Europe evaluate general practice care: an international comparison. Br J Gen Pract. 2000, 50 (460): 882-887.PubMedPubMedCentral
28.
Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM: Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005, 43 (5): 436-444. 10.1097/01.mlr.0000160375.47920.8c.CrossRefPubMed
29.
Glasgow RE, Emont S, Miller DC: Assessing delivery of the five 'As' for patient-centered counseling. Health Promot Int. 2006, 21 (3): 245-255. 10.1093/heapro/dal017.CrossRefPubMed
30.
Morisky DE, Green LW, Levine DM: Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986, 24 (1): 67-74. 10.1097/00005650-198601000-00007.CrossRefPubMed
31.
Glasgow RE, Ory MG, Klesges LM, Cifuentes M, Fernald DH, Green LA: Practical and relevant self-report measures of patient health behaviors for primary care research. Ann Fam Med. 2005, 3 (1): 73-81. 10.1370/afm.261.CrossRefPubMedPubMedCentral
32.
Topolski TD, LoGerfo J, Patrick DL, Williams B, Walwick J, Patrick MB: The Rapid Assessment of Physical Activity (RAPA) among older adults. Prev Chronic Dis. 2006, 3 (4): A118..PubMedPubMedCentral
33.
Segal-Isaacson CJ, Wylie-Rosett J, Gans KM: Validation of a Short Dietary Assessment Questionnaire: The Rapid Eating and Activity Assessment for Participants Short Version (REAP-S). The Diabetes Educator. 2004, 30 (5): 774-781. 10.1177/014572170403000512.CrossRefPubMed
34.
Yaroch AL, Nebeling L, Thompson FE, Hurley TG, Hebert JR, Toobert DJ, et al: Baseline Design Elements and Sample Characteristics for Seven Sites Participating in the Nutrition Working Group of the Behavior Change Consortium. J Nutr. 2008, 138 (1): 185S-192.PubMed
35.
Engels Y, Dautzenberg M, Campbell S, Broge B, Boffin N, Marshall M, et al: Testing a European set of indicators for the evaluation of the management of primary care practices. Fam Pract. 2006, 23 (1): 137-147. 10.1093/fampra/cmi091.CrossRefPubMed
36.
Engels Y, Campbell S, Dautzenberg M, Van den HP, Brinkmann H, Szecsenyi J, et al: Developing a framework of, and quality indicators for, general practice management in Europe. Fam Pract. 2005, 22 (2): 215-222. 10.1093/fampra/cmi002.CrossRefPubMed
37.
Campbell SM, Hann M, Hacker J, Burns C, Oliver D, Thapar A, et al: Identifying predictors of high quality care in English general practice: observational study. BMJ. 2001, 323 (7316): 784-10.1136/bmj.323.7316.784.CrossRefPubMedPubMedCentral
38.
Carpiano RM, Flocke SA, Frank SH, Stange KC: Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery. Prev Med. 2003, 36 (2): 131-140. 10.1016/S0091-7435(02)00024-5.CrossRefPubMed
39.
Rao JK, Weinberger M, Kroenke K: Visit-specific expectations and patient-centered outcomes: a literature review. Arch Fam Med. 2000, 9 (10): 1148-1155. 10.1001/archfami.9.10.1148.CrossRefPubMed
40.
Green LA, Fryer GE, Froom P, Culpepper L, Froom J: Opportunities, challenges, and lessons of international research in practice-based research networks: the case of an international study of acute otitis media. Ann Fam Med. 2004, 2 (5): 429-433. 10.1370/afm.224.CrossRefPubMedPubMedCentral
41.
Thiru K, Hassey A, Sullivan F: Systematic review of scope and quality of electronic patient record data in primary care. BMJ. 2003, 326 (7398): 1070-10.1136/bmj.326.7398.1070.CrossRefPubMedPubMedCentral
42.
Heidenreich R, Himmel W, Böckmann H, et al: Documentation of electronic patient records in German general practices: a telephone survey [article in German]. German Journal for Quality in Health Care. 2005, 99 (9): 573-580.
43.
Chan SC, Lee TW, Teoh LC, Abdullah ZC, Xavier G, Sim CK, et al: Audit on cardiovascular disease preventive care in general practice. Singapore Med J. 2008, 49 (4): 311-315.PubMed
44.
de Lusignan S: An educational intervention, involving feedback of routinely collected computer data, to improve cardiovascular disease management in UK primary care. Methods Inf Med. 2007, 46 (1): 57-62.PubMed
45.
Iversen A, Liddell K, Fear N, Hotopf M, Wessely S: Consent, confidentiality, and the Data Protection Act. BMJ. 2006, 332 (7534): 165-169. 10.1136/bmj.332.7534.165.CrossRefPubMedPubMedCentral
46.
Hearnshaw H: Comparison of requirements of research ethics committees in 11 European countries for a non-invasive interventional study. BMJ. 2004, 328 (7432): 140-141. 10.1136/bmj.328.7432.140.CrossRefPubMedPubMedCentral
47.
Byrne G, Morgan J, Kendall S, Offredy M: A critical account of obtaining research governance approval. Nurse Res. 2005, 13 (2): 7-18.CrossRefPubMed
48.
Miksch A, Laux G, Ose D, Joos S, Campbell S, Riens B, et al: Is there a survival benefit within a German primary care-based disease management program?. Am J Manag Care. 2010, 16 (1): 49-54.PubMed
49.
Ashworth M, Jones RH: Pay for performance systems in general practice: experience in the United Kingdom. Med J Aust. 2008, 189 (2): 60-61.PubMed
50.
Hulscher ME, van Drenth BB, van der Wouden JC, Mokkink HG, van Weel C, Grol RP: Changing preventive practice: a controlled trial on the effects of outreach visits to organise prevention of cardiovascular disease. Qual Health Care. 1997, 6 (1): 19-24. 10.1136/qshc.6.1.19.CrossRefPubMedPubMedCentral
51.
Rabin R, de Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001, 33 (5): 337-343. 10.3109/07853890109002087.CrossRefPubMed
Metadata
Title
Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care
Authors
Sabine Ludt
Stephen M Campbell
Jan van Lieshout
Richard Grol
Joachim Szecsenyi
Michel Wensing
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-70

Other articles of this Issue 1/2011

BMC Health Services Research 1/2011 Go to the issue

Research article

Pay-for-performance in disease management: a systematic review of the literature

Research article

Regulated competition in health care: Switching and barriers to switching in the Dutch health insurance system

Correspondence

Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

Research article

Appraisal of literature reviews on end-of-life care for minority ethnic groups in the UK and a critical comparison with policy recommendations from the UK end-of-life care strategy

Study protocol

Managing resources in NHS dentistry: using health economics to inform commissioning decisions

Research article

An ontology-based nurse call management system (oNCS) with probabilistic priority assessment