Improved Delivery of Cardiovascular Care Through Outreach Facilitation

NCT00574808 | Completed Phase 1

• 2 other identifiers: IDOCC937200801
• Study Type: interventional
• Target: 194
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of the proposed study is to implement and evaluate Outreach Facilitation as a means to increase the uptake of evidence-based practice for secondary prevention and management of patients with established CVD and cardiovascular risk factors, in primary care practices throughout the Champlain LHIN. This initiative centers on the use of an Outreach Facilitation Model, in which skilled health professionals known as facilitators (Practice Change Consultants) serve as an expert resource to primary care practices in three areas: a) practice performance assessment, feedback, and consensus building towards goal setting and implementation; b) clinical, technical, organizational resources and practical advice; and c) encouragement to face and move through the challenges associated with implementing system change.

Conditions

Hypertension; Dyslipidemia; Diabetes; Chronic Kidney Disease; Cardiovascular Disease; Stroke; Transient Ischemic Attacks

Keywords

Primary care; Prevention of Cardiovascular Disease; Chronic Disease Management; Chronic Disease Prevention; Chronic Care Model; Outreach Facilitation

Outcome Measures

Primary Outcomes (1)

• Quality of care process index = ∑ of recommended services received by patient/ ∑ of the recommended services for which the patient was eligible

  5 years

Secondary Outcomes (1)

• Quality of care outcome index = ∑ of recommended targets reached / ∑ of the number of targets for which the patient is eligible based on the number of conditions suffered by the patient

  5 years

Study Arms (2)

intervention

EXPERIMENTAL

Outreach Facilitation implementing elements of the Chronic Care Model. The facilitators will provide hands on support to practices and help to implement tools and processes designed to incorporate evidence-based practice into the routine delivery of cardiovascular care. Specifically, they will a) assist with practice performance assessment, feedback, and consensus building towards goal setting, b) offer clinical, technical, organizational resources and practical advice, and c) provide encouragement to face and overcome the challenges of implementing system change.

Other: Outreach Facilitation implementing elements of the Chronic Care Model

control

NO INTERVENTION

Baseline data before implementation of the program will serve as the control. Comparisons will be made between baseline and post-intervention within each divisions of primary care practices as well as between divisions (ie. baseline information from one division will serve as the control for another).

Interventions

Outreach Facilitation implementing elements of the Chronic Care Model OTHER

An outreach facilitator helps the practice identify areas for improvement, set goals and targets, and agree on the processes needed to reach them in order to improve the care delivery within the practices. Each facilitator will be assigned up to 12 practice sites. The first year of program implementation will involve frequent (once every 3-4 weeks) visits to the practices. Afterwards, the intervention will move into a sustainability mode, during which the frequency of visits will decrease to one every 6-8 weeks during the second year, and one every 12-15 weeks during the third year and thereafter. After the first year of program implementation, each facilitator will be able to take on 12 new practices during the second year, while still being able to sustain contact with the previous 12 practices. Similarly, in the third year, another set of 12 practices will begin the "intense" phase of program implementation.

intervention

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Men and women over 40 years of age, who meet at least one of the following criteria:
• have established cardiovascular disease: Coronary Artery Disease, Cerebrovascular disease (documented stroke and/or TIA), and Peripheral Vascular Disease;
• have Diabetes Mellitus;
• have Chronic Kidney Disease ;
• are at high risk for CVD based on a presence of at least three of the following established cardiovascular risk factors: age (males ≥ 45, females ≥ 55), smoker status, hypertension, and dyslipidemia.
• No restrictions will be imposed on the recruitment process; all practices in the region will be eligible to participate.

You may not qualify if:

• see above

Sponsors & Collaborators

• C. T. Lamont Primary Care Research Centre: lead
• Dept of Family Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel: collaborator
• Institute of Population Health, University of Ottawa: collaborator
• Ottawa Heart Institute Research Corporation: collaborator
• Ottawa Cardiovascular Centre: collaborator
• Ottawa Regional Stroke Program: collaborator
• Bruyère Health Research Institute.: collaborator
• Champlain Primary Care Practices: collaborator

Study Sites (1)

Elisabeth Bruyere Health Centre

Ottawa, Ontario, K1N 5C4, Canada

Location

Related Publications (9)

• Lemelin J, Hogg W, Baskerville N. Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care. CMAJ. 2001 Mar 20;164(6):757-63.

  PMID: 11276541 BACKGROUND

• Baskerville NB, Hogg W, Lemelin J. Process evaluation of a tailored multifaceted approach to changing family physician practice patterns improving preventive care. J Fam Pract. 2001 Mar;50(3):W242-9.

  PMID: 11252222 BACKGROUND

• Hogg W, Baskerville N, Lemelin J. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis. BMC Health Serv Res. 2005 Mar 9;5(1):20. doi: 10.1186/1472-6963-5-20.

  PMID: 15755330 BACKGROUND

• Liddy C, Rowan M, Valiquette-Tessier SC, Drosinis P, Crowe L, Hogg W. Improved Delivery of Cardiovascular Care (IDOCC): Findings from Narrative Reports by Practice Facilitators. Prev Med Rep. 2016 Dec 23;5:214-219. doi: 10.1016/j.pmedr.2016.12.018. eCollection 2017 Mar.

  PMID: 28271017 DERIVED

• Deri Armstrong C, Taljaard M, Hogg W, Mark AE, Liddy C. Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data. Trials. 2016 Sep 5;17(1):434. doi: 10.1186/s13063-016-1547-2.

  PMID: 27596224 DERIVED

• Liddy C, Hogg W, Singh J, Taljaard M, Russell G, Deri Armstrong C, Akbari A, Dahrouge S, Grimshaw JM. A real-world stepped wedge cluster randomized trial of practice facilitation to improve cardiovascular care. Implement Sci. 2015 Oct 28;10:150. doi: 10.1186/s13012-015-0341-y.

  PMID: 26510577 DERIVED

• Liddy C, Singh J, Hogg W, Dahrouge S, Deri-Armstrong C, Russell G, Taljaard M, Akbari A, Wells G. Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study. BMC Cardiovasc Disord. 2012 Sep 12;12:74. doi: 10.1186/1471-2261-12-74.

  PMID: 22970753 DERIVED

• Liddy C, Singh J, Hogg W, Dahrouge S, Taljaard M. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study. BMC Fam Pract. 2011 Oct 18;12:114. doi: 10.1186/1471-2296-12-114.

  PMID: 22008366 DERIVED

• Liddy C, Hogg W, Russell G, Wells G, Armstrong CD, Akbari A, Dahrouge S, Taljaard M, Mayo-Bruinsma L, Singh J, Cornett A. Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care. Implement Sci. 2011 Sep 27;6:110. doi: 10.1186/1748-5908-6-110.

  PMID: 21952084 DERIVED

MeSH Terms

Conditions

Hypertension; Dyslipidemias; Diabetes Mellitus; Renal Insufficiency, Chronic; Cardiovascular Diseases; Stroke; Ischemic Attack, Transient

Condition Hierarchy (Ancestors)

Vascular Diseases; Lipid Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Glucose Metabolism Disorders; Endocrine System Diseases; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Ischemia

Study Officials

• Clare E Liddy, MD, MSc

  University of Ottawa

  PRINCIPAL INVESTIGATOR

• William Hogg, MD, MSc

  University of Ottawa

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr.

Study Record Dates

• First Submitted: December 14, 2007
• First Posted: December 17, 2007
• Study Start: April 1, 2007
• Primary Completion: February 1, 2013
• Study Completion: February 1, 2013
• Last Updated: October 6, 2014

Record last verified: 2014-10

Locations

CA (1)