Evidence map›Paper›PMID 27596224›Full record

Trial reportTrials2016

Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data.

Catherine Deri Armstrong, Monica Taljaard, William Hogg, Amy E Mark, Clare Liddy

Registry-linked trialAbstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Trials, 2016. 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 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 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

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
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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

5 authors.

Catherine Deri ArmstrongDepartment of Economics, University of Ottawa, Ottawa, ON, Canada. cdarmstrong@uottawa.ca.
Monica TaljaardClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
William HoggC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
Amy E MarkInstitute for Clinical Evaluative Sciences, Ottawa, ON, Canada.
Clare LiddyC.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.

Funding

CIHR
6 · The paper itself

Abstract

backgroundPractice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC's effect on CVD-related hospitalizations.

methodsIDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC's effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness.

resultsOur sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses.

conclusionsClinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score analysis were neither due to choice of outcome nor relatively short follow-up period.

trial registrationClinicalTrials.gov NCT00574808 , registered on 14 December 2007.

Indexed as

Databases, FactualProcess Assessment, Health CareCardiovascular DiseasesDelivery of Health Care, IntegratedGuideline AdherenceHealth Services ResearchHospitalizationHumansLinear ModelsLogistic ModelsOdds RatioOntarioPatient Care TeamPhysicians, FamilyPractice Guidelines as TopicPractice Patterns, Physicians'Cardiovascular healthPractice facilitationPrimary care

Identifiers

PMID27596224
PMCPMC5011906

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.