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

Abstract

Background: Cardiovascular 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. Methods: Cluster 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 logbinomial regression or robust Poisson regression, if necessary.

Feasibility and acceptability of NIDUS-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial

“…All processes were remote in the pandemic, and engaging in-person may improve retention. Due to the challenges in recruiting agency clients and carers, we will consider collecting client outcomes aggregated at the agency level, using brief HCW or client measures that participating agencies use or agree to adopt routinely, as in previous trials [ 30 ]. Shorter measures such as the EQ-5D may be sufficient for calculating Quality-adjusted life years (QALYs) and have better completion rates, and without the additional burden or consent processes, more clients may complete this [ 31 ].…”

Effect of Integrated Nursing Care Based on Medical Alliance Mode on the Prevention and Treatment of Complications and Self-Efficacy of Patients with Coronary Heart Disease after PCI

“…The data of 120 CHD patients treated from January 2019 to January 2021 were retrospectively analyzed. All patients meeting the following inclusion criteria were included: (1) patients meeting the diagnostic criteria for CHD formulated by the World Health Organization (WHO) [ 11 ], and undergoing PCI treatment to reconstruct blood circulation; (2) patients with no postoperative heartache; (3) patient with the stable condition and good mental state; (4) patients with normal limb function; and (5) patients with complete clinical data. Exclusion criteria: (1) patients who could not communicate with others due to hearing impairment, language disorders, unclear awareness, and other factors; (2) patient dropping out midway or falling off during follow-up; (3) patients with upper limb swelling and skin infection before surgery; (4) patients with severe organ dysfunction; and (5) patients with severe complications before surgery.…”

Age-Related Variation in the Provision of Primary Care Services and Medication Prescriptions for Patients with Cardiovascular Disease

“…A retrospective cross-sectional study was conducted using data from the QUEL study an Australia–based cluster randomised controlled trial that recruited 50 primary care practices across four states, including New South Wales, Victoria, South Australia and Queensland [ 26 ]. Ethics approval has been obtained from the New South Wales Cancer Institute Population and Health Services Research Ethics Committee (no.…”