Lessons Learnt Implementing a Cardiovascular Disease Quality Improvement Intervention in Australian Primary Care: A Mixed Method Evaluation

Abstract Background There are discrepancies between evidence-based guidelines for screening and management of cardiovascular disease (CVD) and implementation in Australian general practice. Quality-improvement (QI) initiatives aim to reduce these gaps. This study evaluated a QI intervention (QPulse) that focussed on CVD assessment and management. MethodsThis mixed-methods study explored the implementation of guidelines and adoption of QI processes in 34 general practices. CVD screening and management were measured pre- and post-intervention. Qualitative analyses examined participants’ Plan-Do-Study-Act (PDSA) goals and in-depth interviews with practice stakeholders focussed on barriers and enablers to implementation and were analysed thematically using Normalisation Process Theory (NPT). ResultsPre- and post-intervention data were available from 15 practices (n=19562 and n=20249, respectively) and in-depth interviews from seven practices. At baseline, 45.0% of patients had their BMI measured and 15.6% had their waist circumference recorded in the past 2 years and blood pressure, lipids and smoking status were measured in 72.5%, 61.5% and 65.3% of patients, respectively. Most high-risk patients (57.5%) were not prescribed risk-reducing medications. After the intervention there were no changes in the documentation and prevalence of risk factors, attainment of BP and lipid targets or prescription of CVD risk-reducing medications. However, there was variation in performance across practices with some showing isolated improvements, such as recording waist circumference (0.7-32.2% pre-intervention to 18.5%-69.8% post-intervention), BMI and smoking assessment. Challenges to implementation included: lack of time, need for technical support, a perceived lack of value for quality improvement work, difficulty disseminating knowledge across the practice team, tensions between the team and clinical staff and a part-time workforce. ConclusionThe implementation barriers associated with this QI program was considerable in Australian GP practices. Findings highlighted they were not able to effectively operationalise the intervention due to numerous factors, ranging from lack of internal capacity and leadership to competing demands and insufficient external support. Trial registrationAustralian New Zealand Clinical Trials Reference Number (ACTRN12615000108516), registered 06/02/2015. Trial protocol can be accessed at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000108516

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What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory

Implementation Science ◽

10.1186/s13012-018-0830-x ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 5

Author(s):

Bindu Patel ◽

Tim Usherwood ◽

Mark Harris ◽

Anushka Patel ◽

Kathryn Panaretto ◽

...

Keyword(s):

Cardiovascular Disease ◽

Quality Improvement ◽

Mixed Methods ◽

Disease Management ◽

Primary Healthcare ◽

Process Theory ◽

Normalisation Process Theory ◽

Quality Improvement Intervention ◽

Healthcare Settings ◽

Improvement Intervention

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Comparison of Cardiovascular Disease Risks of Actual and Perceptions of Men’s that 40-65 Years Old

European Journal of Public Health ◽

10.1093/eurpub/ckz187.066 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

İbrahim Topuz ◽

Sebahat Gozum

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

High Risk ◽

Perceived Risk ◽

Risk Perceptions ◽

Smoking Status ◽

Cvd Risk ◽

Related Factors ◽

Risk Reducing ◽

Very High

Abstract Background Turkey is among the top countries in Europe in coronary mortality in the 45-74 age range. The highest death due to disorders of the circulatory system (50.8%) that is Amasya province. Objective Determine related factors and to compare with actual and perceived cardiovascular disease (CVD) risks of men aged 40-65 living in Amasya. Methods The sample size of cross-sectional and analytical study consisted of 400 people who met the inclusion criteria. Actual CVD risks of men were calculated using HeartScore. Age, systolic blood pressure, total cholesterol measured by blood taken from the capillary and smoking status were used to calculate CVD risk. Actual CVD risk in next decade has been calculated as low, medium, high or very high. Perceived CVD risk in next decade were identified by participants as low, medium, high and very high responses. They also questioned why evaluation of perceived risk. Results It was determined whereas 8.3% of the males had high, 52.5% had a very high level of CVD risk. The main variables affecting actual CVD risk; diastolic blood pressure, BMI and physical activity. 13.3% of males perceived CVD risks at high and 8% at very high. The main variables affecting perceived CVD risk; age and DM. It was found that 48% and 23.8% of males perceived CVD risks lower and higher than actual CVD risk while 28.2% were accurate. Those who perceived CVD risk at a moderate, high and very high think that this is caused by diseases that increase the risk of CVD and smoking. Conclusions Approximately 1/2 men has very high risk of CVD. It was determined that 1/2 men perceived risks are lower with false optimism and couldn’t accurately identify risks of people older and with diabetes. Key messages It can be ensured that develop risk reducing behaviors and individuals with high risk of CVD can raise their awareness. The risk perceptions of males in the very high-risk group from the past to the present are important because they affect their actual risks and risk-reducing behaviors.

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Impact of Sustained Use of a Multifaceted Computerized Quality Improvement Intervention for Cardiovascular Disease Management in Australian Primary Health Care

Journal of the American Heart Association ◽

10.1161/jaha.117.007093 ◽

2017 ◽

Vol 6 (10) ◽

Cited By ~ 4

Author(s):

Bindu Patel ◽

David Peiris ◽

Tim Usherwood ◽

Qiang Li ◽

Mark Harris ◽

...

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

Quality Improvement ◽

Primary Health Care ◽

Disease Management ◽

Quality Improvement Intervention ◽

Primary Health ◽

Sustained Use ◽

Improvement Intervention

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State-wide quality improvement addressing overutilization of neurokinin-1 receptor antagonists.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.8 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 8-8

Author(s):

Emily R. Mackler ◽

Kelly Marie Procailo ◽

Louise Bedard ◽

Jennifer J. Griggs

Keyword(s):

Quality Improvement ◽

Response Rate ◽

Quality Improvement Intervention ◽

Receptor Antagonists ◽

Post Intervention ◽

Improvement Program ◽

Neurokinin 1 Receptor ◽

Order Sets ◽

Neurokinin 1 ◽

Order Set

8 Background: The overuse of neurokinin-1 receptor antagonists (NK1-RAs) is a focus of quality measurement within the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO-QOPI) and the American Board of Internal Medicine (ABIM) as a Choosing Wisely measure. The Michigan Oncology Quality Collaborative (MOQC) is a statewide collaborative with participation of nearly 100% of oncologists. The purpose of this project was to provide quality improvement practice support for deimplementation of NK1-RAs in the upfront prevention of chemotherapy- induced nausea and vomiting (CINV) for low and moderate emetic chemotherapy regimens (QOPI measure SMT28a) to less than 30% in practices across the State, with lower scores indicating better performance. Methods: In 2018, MOQC added the QOPI SMT28a measure as part of its standard quality measure module for collection by all MOQC practices. A quality improvement intervention was initiated that consisted of 1) baseline assessments of measure performance, prescriber knowledge and beliefs, and pre-populated antiemetic order sets, 2) reporting practice and state-level performance to MOQC practices, 3) state-wide CINV education, and 4) a value-based reimbursement (VBR) related to measure performance. Post-intervention performance was assessed with the Fall 2019 and Spring 2020 QOPI-measurement. Results: Responses from a survey assessing pre-populated antiemetic order sets (32/43, 74% response rate), 23% of practices had a pre-populated order set for NK1-RA and/or olanzapine in moderate emetic regimens. The post-education order set survey found that 48% of respondents (25/43, 54% response rate) either modified or were in the process of modifying their order sets. Conclusions: Deimplementation of unnecessary and low value antiemetics in patients receiving low- or moderate emetic chemotherapy was possible via a state-wide quality improvement program that involved performance reporting to practices, collaborative-wide education, modification of standing order sets, and VBR based on performance. [Table: see text]

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P207 A quality improvement intervention to increase pneumococcal and influenza vaccination rates in immunosuppressed inflammatory arthritis patients

Rheumatology ◽

10.1093/rheumatology/keaa111.202 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Kieran Murray ◽

Candice Low ◽

Francis Young ◽

Anna O'Rourke ◽

Ian Callanan ◽

...

Keyword(s):

Quality Improvement ◽

Influenza Vaccination ◽

Point Of Care ◽

Low Cost ◽

Smart Phone ◽

Binary Logistic Regression ◽

Quality Improvement Intervention ◽

Binary Logistic Regression Analysis ◽

Post Intervention ◽

Vaccination Rates

Abstract Background Pneumococcal and influenza vaccination rates have been suboptimal in studies of immunosuppressed patients. We aimed to assess barriers to and increase rates of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and influenza vaccination in this group. Methods In 2017, Rheumatology outpatients completed an anonymous questionnaire recording vaccination knowledge, status and barriers. Simultaneously, a low-cost multifaceted quality improvement (QI) intervention was performed. All outpatients on oral steroids, immunosuppressant conventional synthetic disease modifying antirheumatic drugs (csDMARDs) or biologics (bDMARDs) were included in the study. In 2018, post-intervention, the clinic was re-assessed. Demographics, diagnosis, medications, smart phone access and willingness to use this for vaccination reminders were assessed for independent vaccination predictors using binary logistic regression analysis. Results 425 patients were included (72.6% rheumatoid arthritis, 74% women, 45.6% ≥60 years old). From 2017-2018, vaccination rates increased for PPSV23 {41.0% to 47.2% (p = 0.29)} and influenza {61.8% to 62.1% (p = 0.95)}. The most common reason for non-vaccination was lack of awareness. Following the intervention, this decreased for influenza (36.7% to 34.2%) and PPSV23 (82.1% to 76.4%). General Practitioners performed most vaccinations, only 3.6% were delivered in hospital. Significant predictors of PPSV23 vaccination were older age {≥80 years had an OR 41.66 (95% CI 3.69-469.8, P = 0.003), compared to ≤ 39 years}, bDMARD use (OR 2.80, 95% CI 1.24-6.32, P = 0.013) and adequate influenza vaccination (OR 9.01, 95% CI 4.40-18.42, P < 0.001). Up to date PPSV23 vaccination (OR 8.93, 95% CI 4.39-18.17, P < 0.001) predicted influenza vaccination. Conclusion PPSV23 and influenza vaccination rates were suboptimal and increased marginally. Point-of-care vaccination may be more effective. Disclosures K. Murray: None. C. Low: None. F. Young: None. A. O'Rourke: None. I. Callanan: None. E. Feeney: None. D. Veale: None.

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Impact of a Pharmacist-Driven Protocol to Improve Guideline-Concordant Prescribing of Diabetes Medications in Patients With Atherosclerotic Cardiovascular Disease: A Pilot Study

Journal of Pharmacy Practice ◽

10.1177/0897190020958245 ◽

2020 ◽

pp. 089719002095824

Author(s):

Dakota L. Freudenberg ◽

Les P. Covington ◽

Rodney B. Young ◽

Nicole D. Lopez ◽

Miti V. Patel ◽

...

Keyword(s):

Cardiovascular Disease ◽

Clinical Pharmacist ◽

Diabetes Management ◽

System Level ◽

Atherosclerotic Cardiovascular Disease ◽

Inclusion Criteria ◽

Post Intervention ◽

Patient Outreach ◽

Risk Reducing ◽

Service Presentation

Purpose: To determine whether a pharmacist-driven protocol improves guideline-concordant prescribing of diabetes medications in patients with atherosclerotic cardiovascular disease (ASCVD). Methods: A retrospective pre- and post-intervention study was conducted at a university-based family medicine clinic. A pharmacist-driven protocol was implemented which involved the creation of an algorithm recommending specific diabetes medications in patients with ASCVD. An in-service presentation reviewing the algorithm and process for referral of eligible patients to an appointment with a clinical pharmacist was delivered to providers. Clinical pharmacist appointments focus was on improving diabetes management and initiating cardiovascular risk-reducing medications if appropriate. Results: A total of 234 patients were screened, and 108 met inclusion criteria. Upon completion of patient outreach, 34% were scheduled with a pharmacist. Forty-three percent of patients (16 of 37) attended the appointment. Of those, 31% were initiated on an evidence-based regimen indicated for diabetes and ASCVD. In comparing pre- to post-implementation of the pharmacist-driven protocol, the rate of guideline-concordant prescribing increased by 48% (3.8% to 5.6%). Conclusion: Implementation of a pharmacist-driven protocol can increase guideline-concordant prescribing. However, further exploration of patient- and system-level barriers is necessary to implement such a program more broadly.

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Interdisciplinary Systems-Based Intervention to Improve IV Hydration during Parenteral Administration of Acyclovir

The Canadian Journal of Hospital Pharmacy ◽

10.4212/cjhp.v69i1.1517 ◽

2016 ◽

Vol 69 (1) ◽

Author(s):

Lisa Dubrofsky ◽

Ryan S Kerzner ◽

Chloë Delaunay ◽

Camille Kolenda ◽

Jocelyne Pepin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Quality Improvement ◽

Protective Factor ◽

Primary Outcome ◽

Kidney Injury ◽

Quality Improvement Intervention ◽

Intervention Period ◽

Post Intervention ◽

Mise En Œuvre ◽

Improvement Intervention

ABSTRACTBackground: Intravenous (IV) hydration is considered a protective factor in reducing the incidence of acyclovir- induced nephrotoxicity. A systems based review of cases of acyclovir-associated acute kidney injury can be used to examine institution-, care provider-, and task-related factors involved in administering the drug and can serve as a basis for developing a quality improvement intervention to achieve safer administration of acyclovir.Objectives: To explore the effectiveness of the study institution’s inter - disciplinary quality improvement intervention in increasing the dilution of acyclovir before IV administration.Methods: After conducting a systems-based review for intervention development, a retrospective analysis was undertaken to compare IV administration of acyclovir in the 6-month periods before and after implementation of the intervention. The study population was a sequential sample of all patients over 18 years of age who were seen in the emergency department or admitted to a ward and who received at least one IV dose of acyclovir at the study institution. The primary outcome was the volume in which each acyclovir dose was delivered. The secondary outcomes were the hourly rate of fluid administration, the frequency of an increase in hourly hydration rate, and the incidence of acute kidney injury.Results: Eighty-four patients (44 in the pre-intervention period and 40 in the post-intervention period) received IV acyclovir and had evaluable data for the primary outcome. The median volume in which the acyclovir dose was administered was significantly higher in the post-intervention group (250 mL versus 100 mL, p < 0.001).Conclusions: In this study, an easily implemented intervention significantly increased the volume of IV fluid administered to patients receiving acyclovir. Adequately powered prospective studies are suggested to investigate the effectiveness of this intervention on the clinically relevant incidence of acyclovir-induced nephrotoxicity.RÉSUMÉContexte : L’hydratation par voie intraveineuse est considérée comme un facteur de protection aidant à réduire l’incidence des cas de néphrotoxicité associés à l’acyclovir. Une analyse de systèmes des cas d’insuffisance rénale aiguë associés à l’acyclovir peut servir à examiner les facteurs liés aux établissements, aux fournisseurs de soins et aux tâches qui touchent l’administration du médicament et à générer ainsi une mesure visant l’amélioration de la qualité qui rendra l’administration d’acyclovir plus sûre.Objectif : Étudier l’efficacité de la mesure interdisciplinaire visant l’amélioration de la qualité qui a été mise en oeuvre dans l’établissement de l’étude et qui encourageait à diluer davantage l’acyclovir avant son administration par voie intraveineuse.Méthodes : Après avoir procédé à une analyse de systèmes pour générer une mesure d’intervention, une analyse rétrospective a été réalisée afin de comparer l’administration d’acyclovir par voie intraveineuse au cours des six mois précédant et suivant la mise en oeuvre de la mesure. La population de l’étude était composée d’un échantillon progressif de tous les patients de plus de 18 ans ayant séjourné aux urgences ou dans un service intra-hospitalier et ayant reçu au moins une dose d’acyclovir par voie intraveineuse dans l’établissement concerné. Le principal parameter d’évaluation était le volume de liquide contenant chaque dose d’acyclovir administrée. Les paramètres d’évaluation secondaires comprenaient : le débit horaire de liquide administré, la fréquence d’ajustement à la hausse du débit liquidien horaire et la fréquence des cas d’insuffisance rénale aiguë.Résultats : Quatre-vingt-quatre patients (44 dans la période précédant l’application de la mesure et 40 dans la période la suivant) ont reçu de l’acyclovir par voie intraveineuse et présentaient des données évaluables pour le paramètre principal. Le volume médian avec lequel chaque dose d’acyclovir était administrée était significativement supérieur dans le groupe suivant l’application de la mesure (250 mL contre 100 mL, p < 0,001).Conclusions : Cette étude montre qu’une mesure facile à mettre en place augmentait de façon significative le volume de liquides intraveineux administré aux patients recevant de l’acyclovir. L’on suggère de réaliser des études prospectives d’une puissance suffisante pour évaluer l’efficacité de cette mesure en ce qui a trait à la fréquence cliniquement significative des cas de néphrotoxicité associés à l’acyclovir.

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Distribution and Correlates of C-Reactive Protein Concentrations among Adult US Women

Clinical Chemistry ◽

10.1373/clinchem.2003.027359 ◽

2004 ◽

Vol 50 (3) ◽

pp. 574-581 ◽

Cited By ~ 133

Author(s):

Earl S Ford ◽

Wayne H Giles ◽

Ali H Mokdad ◽

Gary L Myers

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Hormone Replacement Therapy ◽

Waist Circumference ◽

Glycated Hemoglobin ◽

Smoking Status ◽

Hormone Replacement ◽

C Reactive Protein ◽

C Peptide ◽

Reactive Protein

Abstract Background: Understanding the distribution of C-reactive protein (CRP) concentration among adult women in the US helps to establish the magnitude of women at increased risk for cardiovascular disease. Methods: We examined the distribution and correlates of CRP, using data from 2205 women ≥20 years of age from the National Health and Nutrition Examination Survey 1999–2000. CRP was measured with a high-sensitivity latex-enhanced turbidimetric assay. Results: CRP concentration ranged from 0.1 to 296.0 mg/L (median, 2.7 mg/L). After exclusion of women with a CRP concentration >10 mg/L, the median was 2.2 mg/L. Approximately 25.7% of women, representing ∼26.8 million women, did not report using hormone replacement therapy and had a CRP concentration >3.0 to 10 mg/L, a category considered to indicate high risk for cardiovascular disease. Multiple linear regression analysis included age, race or ethnicity, education, smoking status, total cholesterol concentration, triglyceride concentration, systolic blood pressure, waist circumference, and concentrations of glucose, insulin, c-peptide, and glycated hemoglobin. CRP concentration varied by race or ethnicity (Mexican American > white) and hormone replacement therapy (users > nonusers). In addition, significant and independent associations existed between CRP and waist circumference, total cholesterol and triglyceride concentrations, and systolic blood pressure but not age, smoking status, alcohol use, insulin concentration, glycated hemoglobin, and c-peptide concentration. Conclusion: Large numbers of US women have an increased concentration of CRP.

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