Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22598
Title: QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with coronary heart disease (QUEL): protocol for a 24-month cluster randomised controlled trial in primary care.
Authors: Redfern, Julie;Hafiz, Nashid;Hyun, Karice;Knight, Andrew;Hespe, Charlotte;Chow, Clara K;Briffa, Tom;Gallagher, Robyn;Reid, Christopher;Hare, David L;Zwar, Nicholas;Woodward, Mark;Jan, Stephen;Atkins, Emily R;Laba, Tracey-Lea;Halcomb, Elizabeth;Billot, Laurent;Johnson, Tracey;Usherwood, Timothy
Affiliation: Primary ageind Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia
Sydney Nursing School, Faculty of Medcine and Health, University of Sydney, Sydney, Australia
School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, Australia
School of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia
University of New South Wales, Sydney, Australia
The George Institute for Global Health, University of Oxford, Oxford, UK..
Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, PO Box 154 Westmead, Sydney, NSW, 2154, Australia
Western Sydney Local Health District, Sydney, Australia
The George Institute for Global Health, Sydney, Australia
Department of General Practice and Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Inala Primary Care, Brisbane, Queensland, Australia
School of Nursing, University of Wollongong, Wollongong, Australia
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Heidelberg, Australia
School of Public Health, Curtin University and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Austin Health, Heidelberg, Victoria, Australia
Issue Date: 14-Feb-2020
EDate: 2020-02-14
Citation: BMC family practice 2020; 21(1): 36
Abstract: Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disability globally. A large proportion of mortality occurs in people with prior CHD and effective and scalable strategies are needed to prevent associated deaths and hospitalisations. The aim of this study is to determine if a practice-level collaborative quality improvement program, focused on patients with CHD, reduces the rate of unplanned CVD hospitalisations and major adverse cardiovascular events, and increases the proportion of patients achieving risk factor targets at 24 months. Cluster randomised controlled trial (cRCT) to evaluate the effectiveness of a primary care quality improvement program in 50 primary care practices (n~ 10,000 patients) with 24-month follow-up. Eligible practices will be randomised (1:1) to participate in either the intervention (collaborative quality improvement program) or control (standard care) regimens. Outcomes will be assessed based on randomised allocation, according to intention-to-treat. The primary outcome is the proportion of patients with unplanned CVD hospitalisations at 2 years. Secondary outcomes are proportion of patients with major adverse cardiovascular events, proportion of patients who received prescriptions for guideline-recommended medicines, proportion of patients achieving national risk factor targets and proportion with a chronic disease management plan or review. Differences in the proportion of patients who are hospitalised (as well as binary secondary outcomes) will be analysed using log-binomial regression or robust Poisson regression, if necessary. Despite extensive research with surrogate outcomes, to the authors' knowledge, this is the first randomised controlled trial to evaluate the effectiveness of a data-driven collaborative quality improvement intervention on hospitalisations, CVD events and cardiovascular risk amongst patients with CHD in the primary care setting. The use of data linkage for collection of outcomes will enable evaluation of this potentially efficient strategy for improving management of risk and outcomes for people with heart disease. Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134 (dated 20th December 2019).
URI: http://ahro.austin.org.au/austinjspui/handle/1/22598
DOI: 10.1186/s12875-020-01105-0
ORCID: 0000-0001-8707-5563
PubMed URL: 32059641
Type: Journal Article
Subjects: Cardiovascular disease
Coronary heart disease
Data
Data linkage
Health services
Primary care
Quality improvement
Secondary prevention
Appears in Collections:Journal articles

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