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首页> 外文期刊>Circulation. Cardiovascular quality and outcomes >Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial
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Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial

机译：计算机辅助质量改进计划对初级保健中心血管疾病风险管理的影响：使用电子决策支持聚类随机试验的心血管疾病治疗

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Background: Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Methods and Results: Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged >35 years and others aged ≥45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38 725 patients (mean age, 61.0 years; 42% men) was 17.5 months. Mean monthly staff support was <1 hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio; 1.25; 95% confidence interval, 1.04-1.50; P=0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10308; 56.8% versus 51.2%; P=0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7%; P<0.001), lipid-lowering (19.2% versus 4.8%; P<0.001), and blood pressure-lowering medications (23.3% versus 12.1%; P=0.02). Conclusions: In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the highrisk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. Clinical Trial Registration: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910.
机译：背景：尽管有有效的治疗方法可以降低心血管疾病的风险，但其转化为实践的方法仍然有限。方法和结果：我们在澳大利亚的60个初级保健中心进行了平行分组的随机对照试验，我们测试了包括计算机决策支持，审计/反馈工具和员工培训在内的多方面质量改进干预措施是否改善了（1）指南指示的风险因素测量和（2）针对心血管疾病高风险人群的指导性用药。中心必须使用兼容的软件系统，合格的患者应定期参加（年龄大于35岁的原住民和托雷斯海峡岛民，其他年龄≥45岁的人）。使用广义估计方程式进行了患者水平分析以说明聚类情况。 38 725名患者（平均年龄，61.0岁; 42％的男性）的中位随访时间为17.5个月。平均每月员工支持少于1小时/站点。对于共同的主要结局，干预措施与改善的总体危险因素测量结果相关（62.8％相对于53.4％的危险比; 1.25; 95％的置信区间，1.04-1.50; P = 0.02），但推荐的处方并没有显着差异高危人群（n = 10308; 56.8％对51.2％; P = 0.12）。抗血小板药物（17.9％比2.7％; 2.7％; P <0.001），降脂药物（19.2％比4.8％; P <0.001）和降血压药物的治疗水平有明显提高（新处方或药物增加）。 23.3％和12.1％; P = 0.02）。结论：在澳大利亚的初级卫生保健机构中，以计算机为指导的质量改善干预措施要求的支持最少，可以改善心血管疾病的风险测量，但不会增加高危人群的处方率。计算机化的质量改进工具为提高心血管疾病风险管理的主要医疗保健系统能力提供了一个重要的解决方案，尽管是部分解决方案。临床试验注册：URL：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630。澳大利亚新西兰临床试验注册号12611000478910。

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