Evidence map›Paper›PMID 32059641›Full record

ArticleBMC family practice2020

QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with coronary heart disease (QUEL): protocol for a 24-month cluster randomised controlled trial in primary care.

Julie Redfern, Nashid Hafiz, Karice Hyun, Andrew Knight, Charlotte Hespe, Clara K Chow, Tom Briffa, Robyn Gallagher, Christopher Reid, David L Hare and 9 more

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC family practice, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 3 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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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

19 authors.

Julie RedfernWestmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, PO Box 154 Westmead, Sydney, NSW, 2154, Australia. julie.redfern@sydney.edu.au.ORCID 0000-0001-8707-5563
Nashid HafizWestmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, PO Box 154 Westmead, Sydney, NSW, 2154, Australia.
Karice HyunWestmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, PO Box 154 Westmead, Sydney, NSW, 2154, Australia.
Andrew KnightPrimary ageind Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia.
Charlotte HespeSchool of Medicine Sydney, The University of Notre Dame Australia, Sydney, Australia.
Clara K ChowWestmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, PO Box 154 Westmead, Sydney, NSW, 2154, Australia.
Tom BriffaSchool of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, Australia.
Robyn GallagherSydney Nursing School, Faculty of Medcine and Health, University of Sydney, Sydney, Australia.
Christopher ReidSchool of Public Health, Curtin University and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
David L HareFaculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Austin Health, Heidelberg, Australia.
Nicholas ZwarFaculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
Mark WoodwardUniversity of New South Wales, Sydney, Australia.
Stephen JanThe George Institute for Global Health, Sydney, Australia.
Emily R AtkinsThe George Institute for Global Health, Sydney, Australia.
Tracey-Lea LabaCentre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia.
Elizabeth HalcombSchool of Nursing, University of Wollongong, Wollongong, Australia.
Laurent BillotThe George Institute for Global Health, Sydney, Australia.
Tracey JohnsonInala Primary Care, Brisbane, Queensland, Australia.
Timothy UsherwoodThe George Institute for Global Health, Sydney, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disability globally. A large proportion of mortality occurs in people with prior CHD and effective and scalable strategies are needed to prevent associated deaths and hospitalisations. The aim of this study is to determine if a practice-level collaborative quality improvement program, focused on patients with CHD, reduces the rate of unplanned CVD hospitalisations and major adverse cardiovascular events, and increases the proportion of patients achieving risk factor targets at 24 months.

methodsCluster randomised controlled trial (cRCT) to evaluate the effectiveness of a primary care quality improvement program in 50 primary care practices (n~ 10,000 patients) with 24-month follow-up. Eligible practices will be randomised (1:1) to participate in either the intervention (collaborative quality improvement program) or control (standard care) regimens. Outcomes will be assessed based on randomised allocation, according to intention-to-treat. The primary outcome is the proportion of patients with unplanned CVD hospitalisations at 2 years. Secondary outcomes are proportion of patients with major adverse cardiovascular events, proportion of patients who received prescriptions for guideline-recommended medicines, proportion of patients achieving national risk factor targets and proportion with a chronic disease management plan or review. Differences in the proportion of patients who are hospitalised (as well as binary secondary outcomes) will be analysed using log-binomial regression or robust Poisson regression, if necessary. DISCUSSION: Despite extensive research with surrogate outcomes, to the authors' knowledge, this is the first randomised controlled trial to evaluate the effectiveness of a data-driven collaborative quality improvement intervention on hospitalisations, CVD events and cardiovascular risk amongst patients with CHD in the primary care setting. The use of data linkage for collection of outcomes will enable evaluation of this potentially efficient strategy for improving management of risk and outcomes for people with heart disease.

trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134 (dated 20th December 2019).

Indexed as

Primary Health CareSecondary PreventionAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAustraliaBlood PressureBlood Pressure DeterminationCholesterol, LDLCoronary DiseaseDisease ManagementGuideline AdherenceHospitalizationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsPlatelet Aggregation InhibitorsPractice Guidelines as TopicAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCholesterol, LDLHydroxymethylglutaryl-CoA Reductase InhibitorsPlatelet Aggregation InhibitorsCardiovascular diseaseCoronary heart diseaseDataData linkageHealth servicesPrimary careQuality improvementSecondary prevention

Identifiers

PMID32059641
PMCPMC7020350

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

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.