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 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2016

Open Access 01-12-2016 | Research

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

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

Published in: Trials | Issue 1/2016

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
2.
Hogg W, Lemelin J, Moroz I, Soto E, Russell G. Improving prevention in primary care: evaluating the sustainability of outreach facilitation. Can Fam Physician. 2008;54(5):712–20.PubMedPubMedCentral
3.
Kottke TE, Solberg LI, Brekke ML, Conn SA, Maxwell P, Brekke MJ. A controlled trial to integrate smoking cessation advice into primary care practice: Doctors Helping Smokers, Round III. J Fam Pract. 1992;34(6):701–8.PubMed
4.
Dietrich AJ, O’Connor GT, Keller A, Carney PA, Levy D, Whaley FS. Cancer: improving early detection and prevention. A community practice randomized trial. BMJ. 1992;304(6828):687–91.CrossRefPubMedPubMedCentral
5.
6.
Nagykaldi Z, Mold JW, Aspy CB. Practice facilitators: a review of the literature. Fam Med. 2005;37(8):581–8.PubMed
7.
McCowan C, Neville RG, Crombie IK, Clark RA, Warner FC. The facilitator effect: results from a four-year follow-up of children with asthma. Br J Gen Pract. 1997;47(416):156–60.PubMedPubMedCentral
8.
Roetzheim RG, Christman LK, Jacobsen PB, Schroeder J, Abdulla R, Hunter S. Long-term results from a randomized controlled trial to increase cancer screening among attendees of community health centers. Ann Fam Med. 2005;3(2):109–14.CrossRefPubMedPubMedCentral
9.
Crabtree BF, Nutting PA, Miller WL, Strange KC, Stewart EE, Jaén CR. Summary of the National Demonstration Project and recommendations for the patient-centered medical home. Ann Fam Med. 2010;8 Suppl 1:S80–90.CrossRefPubMedPubMedCentral
10.
Liddy C, Hogg W, Russell G, Wells G, Armstrong CD, Akbari A, et al. Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care. Implement Sci. 2011;6:110.CrossRefPubMedPubMedCentral
11.
Liddy C, Hogg W, Singh J, Taljaard M, Russell G, Deri Armstrong C, Akbari A, Dahrouge S, Grimshaw JM. A real-world stepped wedge cluster randomized trial of PF to improve cardiovascular care. Implement Sci. 2015;10(1):150.CrossRefPubMedPubMedCentral
12.
Frijling BD, Lobo CM, Hulscher ME, Akkermans RP, van Drenth BB, Prins A, et al. Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice. Qual Saf Health Care. 2003;12(3):181–7.CrossRefPubMedPubMedCentral
13.
Lobo CM, Frijling BD, Hulscher ME, Bernsen R, Braspenning JC, Grol RP, et al. Improving quality of organizing cardiovascular preventive care in general practice by outreach visitors: a randomized controlled trial. Prev Med. 2002;35(5):422–9.CrossRefPubMed
14.
Frijling B, Hulscher ME, van Leest LA, Braspenning JC, van den Hoogen H, Drenthen AJ, et al. Multifaceted support to improve preventive cardiovascular care: a nationwide, controlled trial in general practice. Br J Gen Pract. 2003;53(497):934–41.PubMedPubMedCentral
15.
Campbell MK, Piaggio G, Elbourne DR, Altman DG, CONSORT Group. Consort 2010 statement: extension to cluster randomized trials. BMJ. 2012;345:e5661.CrossRefPubMed
16.
17.
Weijer C, Grimshaw JM, Eccles MP, McRae AD, White A, Brehaut JC, et al. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials. PLoS Med. 2012;9(11):e1001346.CrossRefPubMedPubMedCentral
18.
Wranik D, Durier-Copp M. Physician remuneration methods for family physicians in Canada: expected outcomes and lessons learned. Health Care Anal. 2010;18(1):35–59.CrossRefPubMed
19.
20.
Weiner JP, editor. The Johns Hopkins University Bloomberg School of Public Health, Health Services Research & Development Center. The Johns Hopkins ACG® Case-Mix System Reference Manual Version 7.0. 2005.
21.
Li P, Redden DT. Comparing denominator degrees of freedom approximations for the generalized linear mixed model in analyzing binary outcome in small sample cluster-randomized trials. BMC Med Res Methodol. 2015;15(1):38.CrossRefPubMedPubMedCentral
22.
Chen Y-F, Hemming K, Stevens AJ, Lilford RJ. Secular trends and evaluation of complex interventions: the rising tide phenomenon. BMJ Qual Saf. 2015;0:1–8. doi:10.​1136/​bmjqs-2015-004372.
23.
Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007;28(2):182–91.CrossRefPubMed
24.
Hogg W, Baskerville N, Lemelin J. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis. BMC Health Serv Res. 2005;5(1):20.CrossRefPubMedPubMedCentral
Metadata
Title
Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data
Authors
Catherine Deri Armstrong
Monica Taljaard
William Hogg
Amy E. Mark
Clare Liddy
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1547-2

Other articles of this Issue 1/2016

Trials 1/2016 Go to the issue

Study protocol

Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery: study protocol for a randomised controlled trial

Study protocol

Dementia and Physical Activity (DAPA) - an exercise intervention to improve cognition in people with mild to moderate dementia: study protocol for a randomized controlled trial

Research

Bayesian accrual prediction for interim review of clinical studies: open source R package and smartphone application

Research

The citation of relevant systematic reviews and randomised trials in published reports of trial protocols

Study protocol

The effects of computer-based mindfulness training on Self-control and Mindfulness within Ambulatorily assessed network Systems across Health-related domains in a healthy student population (SMASH): study protocol for a randomized controlled trial

Study protocol

The biomechanical effect of acupuncture for poststroke cavovarus foot: study protocol for a randomized controlled pilot trial