A Multimethod Quality Improvement Intervention To Improve Preventive Cardiovascular Care: A Cluster Randomized Trial

Ornstein, Steven; Jenkins, Ruth G.; Nietert, Paul J.; Feifer, Chris; Roylance, Loraine F.; Nemeth, Lynne; Corley, Sarah; Dickerson, Lori; Bradford, W. David; Litvin, Cara

doi:10.7326/0003-4819-141-7-200410050-00008

Cited by 125Primary Care and Health OutcomesClinical practice guidelines implementationHealth Promotion and Cardiovascular Prevention

A Multimethod Quality Improvement Intervention To Improve Preventive Cardiovascular Care: A Cluster Randomized Trial

Ornstein, Steven, Jenkins, Ruth G., Nietert, Paul J., Feifer, Chris, Roylance, Loraine F., Nemeth, Lynne, Corley, Sarah, Dickerson, Lori +2 more·2004·Annals of Internal Medicine

DOI 10.7326/0003-4819-141-7-200410050-00008

Open this paper in CoChat — free account

Abstract

BACKGROUND: Research is needed to validate effective and practical strategies for improving the provision of evidence-based medicine in primary care. OBJECTIVE: To determine whether a multimethod quality improvement intervention was more effective than a less intensive intervention for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke. DESIGN: 2-year randomized, controlled clinical trial with the practice as the unit of randomization. SETTING: 20 community-based family or general internal medicine practices in 14 states. All used the same electronic medical record. PARTICIPANTS: 44 physicians, 17 midlevel providers, and approximately 200 staff members; data from the electronic medical records of 87,291 patients. INTERVENTIONS: All practices received copies of practice guidelines and quarterly performance reports. Intervention practices also hosted quarterly site visits to help them adopt quality improvement approaches and participated in 2 network meetings to share "best practice" approaches. MEASUREMENTS: The percentage of indicators at or above predefined targets and the percentage of patients who had achieved each clinical indicator. RESULTS: Intervention practices improved 22.4 percentage points (from 11.3% to 33.7%) in the percentage of indicators at or above the target; control practices improved 16.4 percentage points (from 6.3% to 22.7%). The 6.0-percentage point absolute difference between the intervention and control group was not statistically significant (P > 0.2). Patients in intervention practices had greater improvements than those in control practices for diagnoses of hypertension (improvement difference, 15.7 percentage points [95% CI, 5.2 to 26.3 percentage points]) and blood pressure control in patients with hypertension (improvement difference, 8.0 percentage points [CI, 0.0 to 16.0 percentage points]). LIMITATIONS: The study involved a small number of practices and lacked a pure control group. CONCLUSIONS: Primary care practices that use electronic medical records and receive regular performance reports can improve their adherence to clinical practice guidelines for cardiovascular disease and stroke prevention.

Integrity signals

Registry

Crossref · 10.7326/0003-4819-141-7-200410050-00008

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Ornstein 2004 found statistically significant improvement in only two of 21 outcomes related to preventive cardiovascular care in the primary care setting.
“Ornstein 2004 found statistically significant improvement in only two of 21 outcomes related to preventive cardiovascular care in the primary care setting”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Ornstein 2004
Ornstein 2004 found a difference in overall improvement that was not statistically significant (adjusted RD = 5.5%, P > 0.2).
“and a difference in overall improvement that was not statistically significant (adjusted RD = 5.5%, P > 0.2)”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Ornstein 2004

Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II)
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944 · see citing works
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure<SUBTITLE>The JNC 7 Report</SUBTITLE>
Chobanian, A. V. (2003) · JAMA · doi:10.1001/jama.289.19.2560 · Cited by 25,386 · see citing works
Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial
Writing Group for the Women's Health Initiative Investigators (2002) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.288.3.321 · Cited by 15,889 · see citing works
Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999) · JAMA · doi:10.1001/jama.282.15.1458 · Cited by 6,677 · see citing works
The quality of health care delivered to adults in the United States
McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa022615 · Cited by 5,079 · see citing works
Improving Primary Care for Patients With Chronic Illness
Bodenheimer, T. (2002) · JAMA · doi:10.1001/jama.288.14.1775 · Cited by 2,961 · see citing works
Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in the United States, 1988-2000
Hajjar, I. M. (2003) · JAMA · doi:10.1001/jama.290.2.199 · Cited by 2,399 · see citing works
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary
Hunt, S. A., Baker, D. W., Chin, M. H., Cinquegrani, M. P., Feldman, A. M., Francis, G. S., Ganiats, T. G., Goldstein, S., Gregoratos, G., Jessup, M. L., et al. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01683-7 · Cited by 1,909 · see citing works
AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update
Pearson, T. A., Blair, S. N., Daniels, S. R., Eckel, R. H., Fair, J. M., Fortmann, S. P., Franklin, B. A., Goldstein, L. B., Greenland, P., Grundy, S. M., et al. (2002) · Circulation · doi:10.1161/01.cir.0000020190.45892.75 · Cited by 1,852 · see citing works
Untitled work
Tunis (2003) · doi:10.1001/jama.290.12.1624 · Cited by 1,724 · see citing works
Cardiovascular Medicine at the Turn of the Millennium: Triumphs, Concerns, and Opportunities
D, E. B. M. (1997) · New England Journal of Medicine · doi:10.1056/nejm199711063371906 · Cited by 1,428 · see citing works
Nowy rok, stare problemy, ale i nowe możliwości
Czupryniak, L. (2014) · Via Medica Journals · Cited by 1,192 · see citing works
Principles of Educational Outreach ('Academic Detailing') to Improve Clinical Decision Making
Soumerai, S. B. (1990) · JAMA · doi:10.1001/jama.1990.03440040088034 · Cited by 1,045 · see citing works
Clinical Research to Clinical Practice — Lost in Translation?
Lenfant, C. J. M. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa035507 · Cited by 898 · see citing works
Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports
Weingarten, S. R. (2002) · BMJ · doi:10.1136/bmj.325.7370.925 · Cited by 735 · see citing works
Guidelines for the Evaluation and Management of Heart Failure
Williams, J. F., Bristow, M. R., Fowler, M. B., Francis, G. S., GARSON, A., Gersh, B. J., HAMMER, D. F., Hlatky, M. A., Leier, C. V., Packer, M., et al. (1995) · Circulation · doi:10.1161/01.cir.92.9.2764 · Cited by 662 · see citing works
Management of Patients With Atrial Fibrillation
Prystowsky, E. N., Benson, D. W., Fuster, V., Hart, R. G., Kay, G. N., Myerburg, R. J., Naccarelli, G. V., & Wyse, D. G. (1996) · Circulation · doi:10.1161/01.cir.93.6.1262 · Cited by 643 · see citing works
Standards of Medical Care for Patients With Diabetes Mellitus
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.2007.s33 · Cited by 610 · see citing works
Chronic Illness Management: What Is the Role of Primary Care?
Rothman, A. A., & Wagner, E. H. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-3-200302040-00034 · Cited by 566 · cited 2× · see citing works
“Published systematic reviews point to the importance of multifaceted interventions in increasing adherence to practice guidelines and improving disease control (12, 13).”
Background
Clinical Trials
Meinert, C. L. (1986) · DigitalGeorgetown (Georgetown University Library) · doi:10.1093/acprof:oso/9780195035681.001.0001 · Cited by 509 · see citing works
Preventing heart attack and death in patients with coronary disease
Smith, S. C., Blair, S. N., Criqui, M. H., Fletcher, G. F., Fuster, V., Gersh, B. J., Gotto, A. M., Gould, K. L., Greenland, P., Grundy, S. M., et al. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)90846-g · Cited by 325 · see citing works
Long-Term Absolute Benefit of Lowering Blood Pressure in Hypertensive Patients According to the JNC VI Risk Stratification
Ogden, L. G., He, J., LYDICK, E. G., & Whelton, P. K. (2000) · Hypertension · doi:10.1161/01.hyp.35.2.539 · Cited by 302 · see citing works
ON DESIGN CONSIDERATIONS AND RANDOMIZATION-BASED INFERENCE FOR COMMUNITY INTERVENTION TRIALS
Gail, M. H., Mark, S. D., Carroll, R. J., Green, S. B., & Pee, D. (1996) · Statistics in Medicine · doi:10.1002/(sici)1097-0258(19960615)15:11 · Cited by 249 · see citing works
Methods for Comparing Event Rates in Intervention Studies When the Unit of Allocation is a Cluster
Donner, A. P., & Klar, N. S. (1994) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117247 · Cited by 241 · see citing works
The Ib Phase of Ventricular Arrhythmias in Ischemic In Situ Porcine Heart Is Related to Changes in Cell-to-Cell Electrical Coupling
Smith, W. T., Fleet, W. F., Johnson, T. A., Engle, C. L., & Cascio, W. E. (1995) · Circulation · doi:10.1161/01.cir.92.10.3051 · Cited by 239 · see citing works
Variations in Cholesterol Management Practices of U.S. Physicians
Stafford, R. S., Blumenthal, D., & Pasternak, R. C. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00441-x · Cited by 129 · see citing works
National Patterns and Predictors of β-Blocker Use in Patients With Coronary Artery Disease
Wang, T. J., & Stafford, R. S. (1998) · Archives of Internal Medicine · doi:10.1001/archinte.158.17.1901 · Cited by 68 · see citing works
Design and analysis of group-randomized trials: A review of recent developments
Murray, D. M. (1997) · Annals of Epidemiology · doi:10.1016/s1047-2797(97)80009-9 · Cited by 31 · see citing works
Changing physician practice behavior: the merits of a diagnostic approach.
Woolf, S. H. (2000) · PubMed · Cited by 26 · see citing works
The Computer-Based Patient Record as a CQI Tool in a Family Medicine Center
Ornstein, S. M., Jenkins, R. G., Lee, F. W., et al. (1997) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(16)30324-8 · Cited by 21 · see citing works
Self-citation

Flagged first, then by citations

Sorted by citations

Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Educational outreach visits: effects on professional practice and health care outcomes
O'Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A. D., Odgaard-Jensen, J., Kristoffersen, D. T., Forsetlund, L., Bainbridge, D., Freemantle, N., Davis, D., et al. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000409.pub2 · Cited by 1,279 · see citing works
A Short History of Primary Care Practice-based Research Networks: From Concept to Essential Research Laboratories
Green, L. A., & Hickner, J. (2006) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.19.1.1 · Cited by 187 · see citing works
The Effect of a Quality Improvement Collaborative to Improve Antimicrobial Prophylaxis in Surgical Patients: A Randomized Trial
Kritchevsky, S. B., Braun, B. I., Bush, A. J., Bozikis, M. R., Kusek, L., Burke, J. P., Wong, E. S., Jernigan, J., Davis, C. C., Simmons, B., et al. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-149-7-200810070-00007 · Cited by 61 · see citing works
Finding order in heterogeneity: types of quality-improvement intervention publications
Rubenstein, L. V., Hempel, S., Farmer, M. M., Asch, S. M., Yano, E. M., Dougherty, D., & Shekelle, P. W. (2008) · Quality and Safety in Health Care · doi:10.1136/qshc.2008.028423 · Cited by 52 · see citing works
Promoting preventive health screening through the use of a clinical reminder tool: an accountable care organization quality improvement initiative
Wilkinson, C., Champion, J. D., & Sabharwal, K. (2013) · Journal for Healthcare Quality · doi:10.1111/jhq.12024 · Cited by 20 · see citing works

A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk
Drummen, S., Balogun, S. A., Lahham, A., Bennell, K. L., Hinman, R. S., Callisaya, M. L., Cai, G., Otáhal, P., Winzenberg, T. M., Wang, Z., et al. (2023) · Clinical Rheumatology · doi:10.1007/s10067-022-06477-5 · Cited by 18 · see citing works
Education With Therapeutic Alliance Did Not Improve Symptoms in Patients With Chronic Low Back Pain and Low Risk of Poor Prognosis Compared to Education Without Therapeutic Alliance: A Randomized Controlled Trial
Miyamoto, G. C., Fagundes, F. R. C., Santo, C. D. M. D. E., Teixeira, F. M. D. L., Tonini, T. V., Prado, F. T., & Cabral, C. M. N. (2021) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2021.9636 · Cited by 19 · see citing works
Intensive spa and exercise therapy program for returning to work for low back pain patients: a randomized controlled trial
Nguyen, C., Boutron, I., Rein, C., Baron, G., Sanchez, K., Palazzo, C., Dupeyron, A., Tessier, J.-M., Coudeyre, E., Eschalier, B., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-18311-z · Cited by 24 · see citing works
No evidence for the effectiveness of a multidisciplinary group based treatment program in patients with osteoarthritis of hands on the short term; results of a randomized controlled trial
Stukstette, M. J. P. M., Dekker, J., den Broeder, A. A., Westeneng, J. M., Bijlsma, J. W. J., & van den Ende, C. H. M. (2013) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2013.03.016 · Cited by 45 · see citing works
A Pragmatic Randomized Controlled Trial on the Effectiveness and Safety of Pharmacopuncture for Chronic Lower Back Pain
Park, K. S., Kim, C., Kim, J. W., Kim, S., Lee, J. Y., Lee, Y. J., Lee, J., Kim, M. J., Choi, Y. E., Yang, C., et al. (2023) · Journal of Pain Research · doi:10.2147/jpr.s413512 · Cited by 14 · see citing works

Authors: Ornstein, S., Jenkins, R. G., Nietert, P. J., Feifer, C., Roylance, L. F., Nemeth, L., Corley, S., Dickerson, L., Bradford, W. D., & Litvin, C.
Affiliations: University of Southern California (US)
ORCID: Jenkins, Ruth G.
Nietert, Paul J.
Nemeth, Lynne
Corley, Sarah
Bradford, W. David
Litvin, Cara
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2004-10-05
Volume: 141
Issue: 7
Pages: 523-532
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-141-7-200410050-00008
OpenAlex: W2083613800
Cited by: 125
References: 30
Citations by year: 2026: 2 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 1 · 2015: 5 · 2014: 2 · 2013: 5 · 2012: 7
FWCI: 24.16
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (1 U18 HS11132-01)
Topics: Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords: quality improvement intervention, cardiovascular disease prevention, stroke prevention, primary care, guideline adherence, quality indicators, performance reports, electronic health records, hypertension diagnosis, blood pressure control
MeSH terms: Adult, Cardiovascular Diseases, Family Practice, Feedback, Female, Humans, Internal Medicine, Male, Medical Audit, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence, Quality Indicators, Health Care, Stroke

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

A Multimethod Quality Improvement Intervention To Improve Preventive Cardiovascular Care: A Cluster Randomized Trial

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks