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Implementation Science
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Study protocol

Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

Authors: Clare Liddy, William Hogg, Grant Russell, George Wells, Catherine Deri Armstrong, Ayub Akbari, Simone Dahrouge, Monica Taljaard, Liesha Mayo-Bruinsma, Jatinderpreet Singh, Alex Cornett

Published in: Implementation Science | Issue 1/2011

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Abstract

Background

There is a need to find innovative approaches for translating best practices for chronic disease care into daily primary care practice routines. Primary care plays a crucial role in the prevention and management of cardiovascular disease. There is, however, a substantive care gap, and many challenges exist in implementing evidence-based care. The Improved Delivery of Cardiovascular Care (IDOCC) project is a pragmatic trial designed to improve the delivery of evidence-based care for the prevention and management of cardiovascular disease in primary care practices using practice outreach facilitation.

Methods

The IDOCC project is a stepped-wedge cluster randomized control trial in which Practice Outreach Facilitators work with primary care practices to improve cardiovascular disease prevention and management for patients at highest risk. Primary care practices in a large health region in Eastern Ontario, Canada, were eligible to participate. The intervention consists of regular monthly meetings with the Practice Outreach Facilitator over a one- to two-year period. Starting with audit and feedback, consensus building, and goal setting, the practices are supported in changing practice behavior by incorporating chronic care model elements. These elements include (a) evidence-based decision support for providers, (b) delivery system redesign for practices, (c) enhanced self-management support tools provided to practices to help them engage patients, and (d) increased community resource linkages for practices to enhance referral of patients. The primary outcome is a composite score measured at the level of the patient to represent each practice's adherence to evidence-based guidelines for cardiovascular care. Qualitative analysis of the Practice Outreach Facilitators' written narratives of their ongoing practice interactions will be done. These textual analyses will add further insight into understanding critical factors impacting project implementation.

Discussion

This pragmatic, stepped-wedge randomized controlled trial with both quantitative and process evaluations demonstrates innovative methods of implementing large-scale quality improvement and evidence-based approaches to care delivery. This is the first Canadian study to examine the impact of a large-scale multifaceted cardiovascular quality-improvement program in primary care. It is anticipated that through the evaluation of IDOCC, we will demonstrate an effective, practical, and sustainable means of improving the cardiovascular health of patients across Canada.

Trial Registration

ClinicalTrials.gov: NCT00574808
Appendix
Available only for authorised users
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Metadata
Title
Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care
Authors
Clare Liddy
William Hogg
Grant Russell
George Wells
Catherine Deri Armstrong
Ayub Akbari
Simone Dahrouge
Monica Taljaard
Liesha Mayo-Bruinsma
Jatinderpreet Singh
Alex Cornett
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-110

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