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
Background: 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 hospit...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2020
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1140807 http://hdl.handle.net/20.500.11937/80066 |
| _version_ | 1848764153787842560 |
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| author | Redfern, J. Hafiz, N. Hyun, K. Knight, A. Hespe, C. Chow, C.K. Briffa, T. Gallagher, R. Reid, Christopher Hare, D.L. Zwar, N. Woodward, M. Jan, S. Atkins, E.R. Laba, T.L. Halcomb, E. Billot, L. Johnson, T. Usherwood, T. |
| author_facet | Redfern, J. Hafiz, N. Hyun, K. Knight, A. Hespe, C. Chow, C.K. Briffa, T. Gallagher, R. Reid, Christopher Hare, D.L. Zwar, N. Woodward, M. Jan, S. Atkins, E.R. Laba, T.L. Halcomb, E. Billot, L. Johnson, T. Usherwood, T. |
| author_sort | Redfern, J. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: 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.
Methods: 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 logbinomial regression or robust Poisson regression, if necessary.
Discussion
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. |
| first_indexed | 2025-11-14T11:14:50Z |
| format | Journal Article |
| id | curtin-20.500.11937-80066 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:14:50Z |
| publishDate | 2020 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-800662021-01-05T08:07:08Z 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 Redfern, J. Hafiz, N. Hyun, K. Knight, A. Hespe, C. Chow, C.K. Briffa, T. Gallagher, R. Reid, Christopher Hare, D.L. Zwar, N. Woodward, M. Jan, S. Atkins, E.R. Laba, T.L. Halcomb, E. Billot, L. Johnson, T. Usherwood, T. Cardiovascular disease Coronary heart disease Data Data linkage Health services Primary care Quality improvement Secondary prevention Background: 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. Methods: 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 logbinomial regression or robust Poisson regression, if necessary. Discussion 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. 2020 Journal Article http://hdl.handle.net/20.500.11937/80066 10.1186/s12875-020-01105-0 eng http://purl.org/au-research/grants/nhmrc/1140807 http://purl.org/au-research/grants/nhmrc/1143538 http://purl.org/au-research/grants/nhmrc/1080206 http://purl.org/au-research/grants/nhmrc/1149987 http://purl.org/au-research/grants/nhmrc/1105447 http://creativecommons.org/licenses/by/4.0/ fulltext |
| spellingShingle | Cardiovascular disease Coronary heart disease Data Data linkage Health services Primary care Quality improvement Secondary prevention Redfern, J. Hafiz, N. Hyun, K. Knight, A. Hespe, C. Chow, C.K. Briffa, T. Gallagher, R. Reid, Christopher Hare, D.L. Zwar, N. Woodward, M. Jan, S. Atkins, E.R. Laba, T.L. Halcomb, E. Billot, L. Johnson, T. Usherwood, T. 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 |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Cardiovascular disease Coronary heart disease Data Data linkage Health services Primary care Quality improvement Secondary prevention |
| url | http://purl.org/au-research/grants/nhmrc/1140807 http://purl.org/au-research/grants/nhmrc/1140807 http://purl.org/au-research/grants/nhmrc/1140807 http://purl.org/au-research/grants/nhmrc/1140807 http://purl.org/au-research/grants/nhmrc/1140807 http://hdl.handle.net/20.500.11937/80066 |