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Quality indicators for the prevention of cardiovascular disease in primary care
Jessica Hopkins1, Gina Agarwal, Lisa Dolovich
1McMaster University, Hamilton, ON, Canada. j.hopkins@utoronto.ca
Insights
Collecting cardiovascular disease (CVD) prevention quality indicators in primary care is feasible. While indicator collection doesn't consistently predict short-term outcomes, it significantly increases patient and physician behavioral changes for CVD prevention.
Area of Science:
- Primary Care Research
- Cardiovascular Disease Prevention
- Health Services Research
Background:
- Quality indicators are crucial for monitoring and improving cardiovascular disease (CVD) prevention in primary care settings.
- Assessing the feasibility and impact of collecting these indicators is essential for evidence-based practice.
- Previous research has described several quality indicators for CVD prevention, but their practical application needs further evaluation.
Purpose of the Study:
- To evaluate the feasibility and usefulness of collecting nine established quality indicators for cardiovascular disease (CVD) prevention within a primary care setting.
- To determine if the collection of these quality indicators predicts their subsequent collection and influences physician or patient behavior.
- To assess the association between the collection of quality indicators and behavioral changes aimed at reducing CVD risk.
Main Methods:
- A retrospective chart audit was conducted in a family health team in Hamilton, Ontario, serving approximately 30,000 patients.
- A random sample of adult patients (men aged 40-80, women aged 50-80) who underwent complete physical examinations in 2003 were included.
- Data collection focused on the frequency of quality indicator recording, predictive value for subsequent collection, and associated behavioral changes.
Main Results:
- Collection rates for most quality indicators exceeded 50% across 237 reviewed patient charts.
- While specific indicators varied by sex (e.g., obesity checks more frequent in women, blood pressure in men), age significantly predicted repeated cholesterol and blood pressure checks.
- Collection of most indicators, particularly alcohol consumption, was significantly associated with increased patient or physician behavioral changes for CVD prevention.
Conclusions:
- The collection of established quality indicators for primary cardiovascular disease prevention in Canadian primary care is feasible.
- While indicator collection generally does not predict short-term outcomes, it demonstrates a positive association with increased patient and physician behavioral changes.
- These findings support the integration of quality indicator collection into routine primary care to promote cardiovascular health.
Objective:
To determine the feasibility and usefulness of collecting 9 previously described quality indicators of cardiovascular disease (CVD) prevention in primary care.
Design:
Retrospective chart audit.
Setting:
Family health team in Hamilton, Ont, comprising approximately 30 000 patients and 25 physicians over 2 sites.
Participants:
A random sample of community-dwelling men who were 40 to 80 years of age and women who were 50 to 80 years of age on January 1, 2003, and who had complete physical examinations in 2003.
Main Outcome Measures:
The frequency with which quality indicators were collected during the complete physical examination, whether the collection of these indicators predicted subsequent collection of the same indicators, and physician or patient behavioural changes to reduce the risk of CVD.
Results:
Of the 237 patient charts reviewed, 142 were of men and 95 were of women. Collection of most of the quality indicators was high (> 50%). Results were adjusted for age, sex, and family health team site. Measurements to check for obesity were collected more frequently in women, while blood pressure measurements and follow-up when required were completed more frequently in men. The relationship between the collection of an indicator and the subsequent times the same indicator was collected was not significant for any of the variables except excess alcohol consumption, in that collection of the excess alcohol consumption indicator led to a significant increase in subsequent collection of that same indicator (P = .0091). Age significantly predicted the number of times cholesterol and blood pressure were repeatedly checked (P = .0074 and P = .0077, respectively). The collection of these indicators was significantly associated with behavioural changes related to CVD prevention on the part of the patient or physician, with collection of the alcohol consumption indicator being the most likely to encourage subsequent behavioural changes. The only indicator to not reach statistical significance for subsequent changes was the cholesterol indicator (P = .08).
Conclusion:
The collection of previously described quality indicators for the primary prevention of CVD in Canada is feasible. Collection of the indicators does not generally predict short-term outcomes; however, collection of most indicators increased the odds of patient or physician behavioural changes for the primary prevention of CVD.
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