Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control
BackgroundFuture Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical d...
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JMIR Publications
2025-02-01
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| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2025/1/e54147 |
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| author | Jo-Anne Manski-Nankervis Barbara Hunter Natalie Lumsden Adrian Laughlin Rita McMorrow Douglas Boyle Patty Chondros Shilpanjali Jesudason Jan Radford Megan Prictor Jon Emery Paul Amores An Tran-Duy Craig Nelson |
| author_facet | Jo-Anne Manski-Nankervis Barbara Hunter Natalie Lumsden Adrian Laughlin Rita McMorrow Douglas Boyle Patty Chondros Shilpanjali Jesudason Jan Radford Megan Prictor Jon Emery Paul Amores An Tran-Duy Craig Nelson |
| author_sort | Jo-Anne Manski-Nankervis |
| collection | DOAJ |
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BackgroundFuture Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy).
ObjectiveThis study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome).
MethodsGeneral practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE.
ResultsOverall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI –1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use.
ConclusionsFHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19–related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT.
Trial RegistrationACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119 |
| format | Article |
| id | doaj-art-01883e873d3744508e8d70c63025c251 |
| institution | Kabale University |
| issn | 2561-326X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Formative Research |
| spelling | doaj-art-01883e873d3744508e8d70c63025c2512025-02-03T18:30:48ZengJMIR PublicationsJMIR Formative Research2561-326X2025-02-019e5414710.2196/54147Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active ControlJo-Anne Manski-Nankervishttps://orcid.org/0000-0003-2153-3482Barbara Hunterhttps://orcid.org/0000-0002-1268-3166Natalie Lumsdenhttps://orcid.org/0000-0002-7471-2487Adrian Laughlinhttps://orcid.org/0000-0003-3545-4785Rita McMorrowhttps://orcid.org/0000-0002-2835-9504Douglas Boylehttps://orcid.org/0000-0002-4779-7083Patty Chondroshttps://orcid.org/0000-0003-0393-8734Shilpanjali Jesudasonhttps://orcid.org/0000-0001-9695-0761Jan Radfordhttps://orcid.org/0000-0002-5751-0488Megan Prictorhttps://orcid.org/0000-0002-5244-2041Jon Emeryhttps://orcid.org/0000-0002-5274-6336Paul Amoreshttps://orcid.org/0000-0002-3507-2982An Tran-Duyhttps://orcid.org/0000-0002-9558-3004Craig Nelsonhttps://orcid.org/0000-0003-3548-4167 BackgroundFuture Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). ObjectiveThis study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). MethodsGeneral practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. ResultsOverall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI –1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. ConclusionsFHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19–related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. Trial RegistrationACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119https://formative.jmir.org/2025/1/e54147 |
| spellingShingle | Jo-Anne Manski-Nankervis Barbara Hunter Natalie Lumsden Adrian Laughlin Rita McMorrow Douglas Boyle Patty Chondros Shilpanjali Jesudason Jan Radford Megan Prictor Jon Emery Paul Amores An Tran-Duy Craig Nelson Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control JMIR Formative Research |
| title | Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control |
| title_full | Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control |
| title_fullStr | Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control |
| title_full_unstemmed | Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control |
| title_short | Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control |
| title_sort | effectiveness of electronic quality improvement activities to reduce cardiovascular disease risk in people with chronic kidney disease in general practice cluster randomized trial with active control |
| url | https://formative.jmir.org/2025/1/e54147 |
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