Evidence map›Paper›PMID 26510577›Full record

Trial reportImplementation science : IS2015

A real-world stepped wedge cluster randomized trial of practice facilitation to improve cardiovascular care.

Clare Liddy, William Hogg, Jatinderpreet Singh, Monica Taljaard, Grant Russell, Catherine Deri Armstrong, Ayub Akbari, Simone Dahrouge, Jeremy M Grimshaw

Registry-linked trialAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00574808 (Improved Delivery of Cardiovascular Preventive Care), which is not on this map. Cited by 42 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00574808 phase1completednot on this map

Improved Delivery of Cardiovascular Preventive Care (IDOCC) Through Outreach Facilitation

TypeinterventionalSponsorC. T. Lamont Primary Care Research CentreRan2007 to 2013Enrolled194ConditionsHypertension, Dyslipidemia, Diabetes, Chronic Kidney DiseaseArmsOutreach Facilitation implementing elements of the Chronic Care Model
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  6. Risk scoring for the primary prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2017
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  8. Intervention to Improve Psychosocial Care for People with Type 2 Diabetes.Journal of the American Board of Family Medicine : JABFM · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Clare LiddyC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada. cliddy@bruyere.org.
William HoggC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada. whogg@bruyere.org.
Jatinderpreet SinghC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada. jpsingh99@gmail.com.
Monica TaljaardClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. mtaljaard@ohri.ca.
Grant RussellC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada. grant.russell@monash.edu.
Catherine Deri ArmstrongDepartment of Economics, University of Ottawa, Ottawa, Ontario, Canada. cdarmstrong@uottawa.ca.
Ayub AkbariThe Ottawa Hospital, Ottawa, Ontario, Canada. aakbari@toh.on.ca.
Simone DahrougeC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada. sdahrouge@bruyere.org.
Jeremy M GrimshawClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. jgrimshaw@ohri.ca.

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

backgroundPractice facilitation has been associated with meaningful improvements in disease prevention and quality of patient care. Using practice facilitation, the Improved Delivery of Cardiovascular Care (IDOCC) project aimed to improve the delivery of evidence-based cardiovascular care in primary care practices across a large health region. Our goal was to evaluate IDOCC's impact on adherence to processes of care delivery.

methodsA pragmatic stepped wedge cluster randomized trial recruiting primary care providers in practices located in Eastern Ontario, Canada (ClinicalTrials.gov: NCT00574808). Participants were randomly assigned by region to one of three steps. Practice facilitators were intended to visit practices every 3-4 (year 1-intensive) or 6-12 weeks (year 2-sustainability) to support changes in practice behavior. The primary outcome was mean adherence to indicators of evidence-based care measured at the patient level. Adherence was assessed by chart review of a randomly selected cohort of 66 patients per practice in each pre-intervention year, as well as in year 1 and year 2 post-intervention.

resultsEighty-four practices (182 physicians) participated. On average, facilitators had 6.6 (min: 2, max: 11) face-to-face visits with practices in year 1 and 2.5 (min: 0 max: 10) visits in year 2. We collected chart data from 5292 patients. After adjustment for patient and provider characteristics, there was a 1.9 % (95 % confidence interval (CI): -2.9 to -0.9 %) and 4.2 % (95 % CI: -5.7 to -2.6 %) absolute decrease in mean adherence from baseline to intensive and sustainability years, respectively.

conclusionsIDOCC did not improve adherence to best-practice guidelines. Our results showed a small statistically significant decrease in mean adherence of questionable clinical significance. Potential reasons for this result include implementation challenges, competing priorities in practices, a broad focus on multiple chronic disease indicators, and use of an overall index of adherence. These results contrast with findings from previously reported facilitation trials and highlight the complexities and challenges of translating research findings into clinical practice.

trial registrationClinicalTrials.gov NCT00574808.

Indexed as

AdultAgedAged, 80 and overCardiovascular DiseasesEvidence-Based MedicineFemaleGuideline AdherenceHumansMaleMiddle AgedOntarioPractice Guidelines as TopicPractice Patterns, Physicians'Primary Health CareQuality Improvement

Identifiers

PMID26510577
PMCPMC4625868

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.