Effect of an Educational Toolkit on Quality of Care: A Pragmatic Cluster Randomized Trial
Background:
Printed educational materials for clinician education are one of the most commonly used approaches for quality improvement. The objective of this pragmatic cluster randomized trial was to evaluate the effectiveness of an educational toolkit focusing on cardiovascular disease screening and risk reduction in people with diabetes.
Methods and Findings:
All 933,789 people aged ≥40 years with diagnosed diabetes in Ontario, Canada were studied using population-level administrative databases, with additional clinical outcome data collected from a random sample of 1,592 high risk patients. Family practices were randomly assigned to receive the educational toolkit in June 2009 (intervention group) or May 2010 (control group). The primary outcome in the administrative data study, death or non-fatal myocardial infarction, occurred in 11,736 (2.5%) patients in the intervention group and 11,536 (2.5%) in the control group (p = 0.77). The primary outcome in the clinical data study, use of a statin, occurred in 700 (88.1%) patients in the intervention group and 725 (90.1%) in the control group (p = 0.26). Pre-specified secondary outcomes, including other clinical events, processes of care, and measures of risk factor control, were also not improved by the intervention. A limitation is the high baseline rate of statin prescribing in this population.
Conclusions:
The educational toolkit did not improve quality of care or cardiovascular outcomes in a population with diabetes. Despite being relatively easy and inexpensive to implement, printed educational materials were not effective. The study highlights the need for a rigorous and scientifically based approach to the development, dissemination, and evaluation of quality improvement interventions.
Trial Registration: http://www.ClinicalTrials.gov NCT01411865 and NCT01026688
Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Effect of an Educational Toolkit on Quality of Care: A Pragmatic Cluster Randomized Trial. PLoS Med 11(2): e32767. doi:10.1371/journal.pmed.1001588
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001588
Souhrn
Background:
Printed educational materials for clinician education are one of the most commonly used approaches for quality improvement. The objective of this pragmatic cluster randomized trial was to evaluate the effectiveness of an educational toolkit focusing on cardiovascular disease screening and risk reduction in people with diabetes.
Methods and Findings:
All 933,789 people aged ≥40 years with diagnosed diabetes in Ontario, Canada were studied using population-level administrative databases, with additional clinical outcome data collected from a random sample of 1,592 high risk patients. Family practices were randomly assigned to receive the educational toolkit in June 2009 (intervention group) or May 2010 (control group). The primary outcome in the administrative data study, death or non-fatal myocardial infarction, occurred in 11,736 (2.5%) patients in the intervention group and 11,536 (2.5%) in the control group (p = 0.77). The primary outcome in the clinical data study, use of a statin, occurred in 700 (88.1%) patients in the intervention group and 725 (90.1%) in the control group (p = 0.26). Pre-specified secondary outcomes, including other clinical events, processes of care, and measures of risk factor control, were also not improved by the intervention. A limitation is the high baseline rate of statin prescribing in this population.
Conclusions:
The educational toolkit did not improve quality of care or cardiovascular outcomes in a population with diabetes. Despite being relatively easy and inexpensive to implement, printed educational materials were not effective. The study highlights the need for a rigorous and scientifically based approach to the development, dissemination, and evaluation of quality improvement interventions.
Trial Registration: http://www.ClinicalTrials.gov NCT01411865 and NCT01026688
Please see later in the article for the Editors' Summary
Zdroje
1. StewartAL, GreenfieldS, HaysRD, WellsK, RogersWH, et al. (1989) Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 262: 907–913.
2. GreggEW, GuQ, ChengYJ, NarayanKMV, CowieCC (2007) Mortality trends in men and women with diabetes, 1971 to 2000. Ann Intern Med 147: 149–155.
3. DawsonKG, GomesD, GersteinH, BlanchardJF, KahlerKH (2002) The economic cost of diabetes in Canada, 1998. Diabetes Care 25: 1303–1307.
4. American Diabetes Association (2013) Standards of medical care in diabetes–2013. Diabetes Care 36: S11–S66.
5. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (2008) Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 32: S1–S201.
6. International Diabetes Federation Clinical Guidelines Taskforce (2005) Global Guideline For Type 2 Diabetes. Brussels: International Diabetes Federation.
7. HarrisSB, EkoéJ-M, ZdanowiczY, Webster-BogaertS (2005) Glycemic control and morbidity in the Canadian primary care setting (results of the Diabetes in Canada Evaluation study). Diabetes Res Clin Pract 70: 90–97.
8. ShahBR, HuxJE, LaupacisA, ZinmanB, ZwarensteinM (2007) Deficiencies in the quality of diabetes care: comparing specialist with generalist care misses the point. J Gen Intern Med 22: 275–279.
9. SaaddineJB, CadwellB, GreggEW, EngelgauMM, VinicorF, et al. (2006) Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Ann Intern Med 144: 465–474.
10. BrownAF, GreggEW, StevensMR, KarterAJ, WeinbergerM, et al. (2005) Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care 28: 2864–2870.
11. GriffinSJ, Borch-JohnsenK, DaviesMJ, KhuntiK, RuttenGE, et al. (2009) Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial. Lancet 378: 156–167.
12. HolbrookA, ThabaneL, KeshavjeeK, DolovichL, BernsteinB, et al. (2009) for the COMPETE II Investigators (2009) Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial. CMAJ 181: 37–44.
13. O'ConnorPJ, DesaiJ, SolbergLI, RegerLA, CrainAL, et al. (2005) Randomized trial of quality improvement intervention to improve diabetes care in primary care settings. Diabetes Care 28: 1890–1897.
14. PetersonKA, RadosevichDM, O'ConnorPJ, NymanJA, PrineasRJ, et al. (2008) Improving diabetes care in practice: findings from the TRANSLATE trial. Diabetes Care 31: 2238–2243.
15. GrimshawJ, EcclesM, ThomasR, MacLennanG, RamsayC, et al. (2006) Towards evidence-based quality improvement: evidence (and its limitation) of the effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med 21: S14–S20.
16. ShahBR, BhattacharyyaO, YuC, MamdaniM, ParsonsJA, et al. (2010) Evaluation of a toolkit to improve cardiovascular disease screening and treatment for people with type 2 diabetes: protocol for a cluster-randomized pragmatic trial. Trials 11: 44.
17. HuxJE, IvisF, FlintoftV, BicaA (2002) Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 25: 512–516.
18. KiranT, VictorJC, KoppA, ShahBR, GlazierRH (2012) The relationship between financial incentives and quality of diabetes care in Ontario, Canada. Diabetes Care 35: 1038–1046.
19. ShahBR, HuxJE, LaupacisA, ZinmanB, van WalravenC (2005) Clinical inertia in response to inadequate glycemic control: Do specialists differ from primary care physicians? Diabetes Care 28: 600–606.
20. GrossPA, GreenfieldS, CretinS, FergusonJ, GrimshawJ, et al. (2001) Optimal methods for guideline implementation: conclusions from Leeds Castle Meeting. Med Care 39: II-85–II-92.
21. NamS, CheslaC, StottsNA, KroonL, JansonSL (2011) Barriers to diabetes management: Patient and provider factors. Diabetes Res Clin Pract 93: 1–9.
22. MorrishNJ, WangSL, StevensLK, FullerJH, KeenH (2001) Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia 44: S14–S21.
23. RoglicG, UnwinN, BennettPH, MathersC, TuomilehtoJ, et al. (2005) The burden of mortality attributable to diabetes. Diabetes Care 28: 2130–2135.
24. Bhattacharyya OK, Zwarenstein M (2009) Methodologies to evaluate effectiveness of knowledge translation interventions. Straus S, Tetroe J, Graham ID, editors. Knowledge Translation in Health Care: Moving from Evidence to Practice. Chichester, UK: Blackwell Publishing Ltd.
25. GiguèreA, LégaréF, GrimshawJ, TurcotteS, FianderM, et al. (2012) Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database of Syst Rev 10: CD004398.
26. TriccoAC, IversNM, GrimshawJM, MoherD, TurnerL, et al. (2012) Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet 379: 2252–2261.
27. BebbC, KendrickD, CouplandC, MadeleyR, StewartJ, et al. (2007) A cluster randomised controlled trial of the effect of a treatment algorithm for hypertension in patients with type 2 diabetes. Br J Gen Pract 57: 136–143.
28. BeaulieuM-D, BrophyJ, JacquesA, BlaisR, BattistaR, et al. (2004) Drug treatment of stable angina pectoris and mass dissemination of therapeutic guidelines: a randomized controlled trial. QJM 97: 21–31.
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