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A multifaceted quality improvement intervention for CVD risk management in Australian primary healthcare: a protocol
Bindu Patel1, Anushka Patel2, Stephen Jan3
1The George Institute for Global Health, University of Sydney, Sydney, NSW, 2006, Australia. bpatel@georgeinstitute.org.au.
Insights
This study evaluated a quality improvement intervention for cardiovascular disease (CVD) risk management in Australian primary care. The process evaluation aims to understand factors influencing its use, effectiveness, and scalability for better CVD prevention.
Area of Science:
- Public Health
- Health Services Research
- Cardiovascular Medicine
Background:
- Cardiovascular disease (CVD) remains a leading global cause of mortality and disability.
- Despite available guidelines, translating CVD risk management into routine practice is challenging.
- A multifaceted quality improvement intervention was developed and tested in Australian primary care.
Purpose of the Study:
- To conduct a theory-based process evaluation of a CVD risk management intervention.
- To understand how, why, and for whom the intervention produced outcomes.
- To identify factors influencing intervention scalability and sustainability for improved CVD prevention.
Main Methods:
- A mixed-methods approach combining quantitative and qualitative studies.
- Quantitative analyses include long-term effectiveness, correlates of outcomes, and health economic impact.
- Qualitative methods involve provider perspectives, video ethnography, and patient interviews.
Main Results:
- The intervention showed improvements in risk factor recording and guideline-recommended prescribing.
- Understanding of intervention use in practice and influencing factors is still needed.
- This protocol outlines methods to assess intervention impact and inform future implementation.
Conclusions:
- A mixed-methods evaluation will detail the implementation process of a quality improvement intervention.
- Identifies factors crucial for intervention scalability and sustainability.
- Provides insights for optimizing CVD risk management strategies in primary care.
Background:
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Despite the widespread availability of evidence-based clinical guidelines and validated risk predication equations for prevention and management of CVD, their translation into routine practice is limited. We developed a multifaceted quality improvement intervention for CVD risk management which incorporates electronic decision support, patient risk communication tools, computerised audit and feedback tools, and monthly, peer-ranked performance feedback via a web portal. The intervention was implemented in a cluster randomised controlled trial in 60 primary healthcare services in Australia. Overall, there were improvements in risk factor recording and in prescribing of recommended treatments among under-treated individuals, but it is unclear how this intervention was used in practice and what factors promoted or hindered its use. This information is necessary to optimise intervention impact and maximally implement it in a post-trial context. In this study protocol, we outline our methods to conduct a theory-based, process evaluation of the intervention. Our aims are to understand how, why, and for whom the intervention produced the observed outcomes and to develop effective strategies for translation and dissemination.
Methods/Design:
We will conduct four discrete but inter-related studies taking a mixed methods approach. Our quantitative studies will examine (1) the longer term effectiveness of the intervention post-trial, (2) patient and health service level correlates with trial outcomes, and (3) the health economic impact of implementing the intervention at scale. The qualitative studies will (1) identify healthcare provider perspectives on implementation barriers and enablers and (2) use video ethnography and patient semi-structured interviews to understand how cardiovascular risk is communicated in the doctor/patient interaction both with and without the use of intervention. We will also assess the costs of implementing the intervention in Australian primary healthcare settings which will inform scale-up considerations.
Discussion:
This mixed methods evaluation will provide a detailed understanding of the process of implementing a quality improvement intervention and identify the factors that might influence scalability and sustainability.
Trials Registration:
12611000478910.
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