A Comparison of Different Programs To Improve Preventive Care for Cardiovascular Conditions

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The summary below is from the full report titled "A Multimethod Quality Improvement Intervention To Improve Preventive Cardiovascular Care. A Cluster Randomized Trial." It is in the 5 October 2004 issue of Annals of Internal Medicine (volume 141, pages 523-532). The authors are S. Ornstein, R.G. Jenkins, P.J. Nietert, C. Feifer, L.F. Roylance, L. Nemeth, S. Corley, L. Dickerson, W.D. Bradford, and C. Litvin.

What is the problem and what is known about it so far?

Guidelines recommend that doctors incorporate many practices to prevent cardiovascular disease (heart attack and stroke) into routine health care for their patients. These practices include, for example, measurement of blood pressure and cholesterol level and treatment when either is high. Other recommended practices include certain tests and treatments for patients who have conditions such as heart failure or diabetes. Unfortunately, although guidelines recommend various interventions to prevent cardiovascular disease, doctors sometimes forget to include all of these interventions in the care of every patient. Many hospitals and other health care settings have developed programs to improve care, but these programs often have limited success. Some experts believe that quality improvement programs with multiple components are more effective than simpler programs.

Why did the researchers do this particular study?

To determine whether a program to improve preventive cardiovascular care that includes multiple components results in better care than a simpler program.

Who was studied?

20 primary care practices and more than 86 000 patients seen in those practices during the study.

How was the study done?

The researchers assigned each of the 20 practices to participate in either a simple or a multiple-component quality improvement program. The simple program gave each practice copies of guidelines for cardiovascular preventive care. Four times each year, the simple program also gave practices information about how they performed on each of 21 elements of care recommended in the guidelines. The multiple-component program included 6 to 7 practice site visits by quality improvement experts and 2 group meetings attended by representatives from each practice. In addition, the program provided the practices with copies of practice guidelines and performance reports.

What did the researchers find?

Patients in practices assigned to the multicomponent quality improvement program experienced greater improvements in the receipt of guideline-recommended care for cardiovascular disease than did patients in practices that received only the simple program.

What were the limitations of the study?

The study involved a small number of practices and examined only cardiovascular care.

What are the implications of the study?

Programs to improve quality of care seem to be more effective when they include site visits and quality improvement meetings and provide practices with copies of the guidelines and performance reports.