OBJECTIVE: To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. DESIGN: Quasi-experimental study. SETTING: Primary care. Two urban health centres. PARTICIPANTS: A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). INTERVENTIONS: The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. MAIN MEASUREMENTS: Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. RESULTS:Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. CONCLUSIONS: The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.
RCT Entities:
OBJECTIVE: To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. DESIGN: Quasi-experimental study. SETTING: Primary care. Two urban health centres. PARTICIPANTS: A thousand hypertensepatients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). INTERVENTIONS: The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. MAIN MEASUREMENTS: Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. RESULTS: Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. CONCLUSIONS: The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.
Authors: Kunal N Karmali; Stephen D Persell; Pablo Perel; Donald M Lloyd-Jones; Mark A Berendsen; Mark D Huffman Journal: Cochrane Database Syst Rev Date: 2017-03-14
Authors: Isidro Rodríguez-Salceda; Esperanza Escortell-Mayor; Milagros Rico-Blázquez; Rosario Riesgo-Fuertes; Angel Asúnsolo-del Barco; Antonio Valdivia-Pérez; Isabel del Cura-González; Ana B García-Cañón; María F Ortiz-Jiménez; Luisa Cabello-Ballesteros; Sofia Garrido-Elustondo; Laura Chamorro-González; Ricardo Rodríguez-Barrientos Journal: BMC Public Health Date: 2010-07-30 Impact factor: 3.295