Evidence mapPaperPMID 33047340Full record

Trial reportHealth services research2020

A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.

Samuel Cykert, Thomas C Keyserling, Michael Pignone, Darren DeWalt, Bryan J Weiner, Justin G Trogdon, Thomas Wroth, Jacqueline Halladay, Monique Mackey, Jason Fine and 2 more

Open access · greenAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 2 pooled it
4.0field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 2 countries.

Samuel CykertThe Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.ORCID 0000-0003-2037-6809
Thomas C KeyserlingDivision of General Internal Medicine and Clinical Epidemiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Michael PignoneDepartment of Internal Medicine, The Dell Medical School, University of Texas, Austin, Texas, USA.
Darren DeWaltThe Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Bryan J WeinerDepartment of Global Public Health, School of Public Health, University of Washington, Seattle, Washington, USA.
Justin G TrogdonDepartment of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA.ORCID 0000-0001-5484-7870
Thomas WrothCommunity Care of North Carolina, Raleigh, North Carolina, USA.
Jacqueline HalladayThe Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Monique MackeyThe North Carolina Area Health Education Centers Program, Chapel Hill, North Carolina, USA.
Jason FineDepartment of Biostatistics, The Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA.
Jung In KimDepartment of Statistics, Eberly College of Science, The Pennsylvania State University, University Park, Pennsylvania, USA.
Crystal CeneThe Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
University of North Carolina at Chapel Hill · USCoastal Area Health Education Center · USCommunity Care · USDell Children's Medical Center of Central Texas · USPennsylvania State University · USWashington State Department of Health · US

Funding

AHRQ HHS R18 HS023912NCATS NIH HHS UL1 TR002489
6 · The paper itself

Abstract

objectiveTo assess the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. STUDY

settingA total of 219 small primary care practices (≤10 clinicians per site) across North Carolina with primary data collection from electronic health records (EHRs) from the fourth quarter of 2015 through the second quarter of 2018. STUDY

designWe performed a stepped-wedge, stratified, cluster randomized trial of a one-year intervention consisting of practice facilitation utilizing quality improvement techniques coupled with a cardiovascular dashboard that included lists of risk-stratified adults, aged 40-79 years and their unmet treatment opportunities. The primary outcome was change in 10-Year ASCVD Risk score among all patients with a baseline score ≥10 percent from baseline to 3 months postintervention. DATA COLLECTION/ EXTRACTION

methodsData extracts were securely transferred from practices on a nightly basis from their EHR to the research team registry. PRINCIPLE

findingsASCVD risk scores were assessed on 437 556 patients and 146 826 had a calculated 10-year risk ≥10 percent. The mean baseline risk was 23.4 percent (SD ± 12.6 percent). Postintervention, the absolute risk reduction was 6.3 percent (95% CI 6.3, 6.4). Models considering calendar time and stepped-wedge controls revealed most of the improvement (4.0 of 6.3 percent) was attributable to the intervention and not secular trends. In multivariate analysis, male gender, age >65 years, low-income (<$40 000), and Black race (P < .001 for all variables) were each associated with greater risk reductions.

conclusionA risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year ASCVD risk for patients at high risk. Similar approaches could lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices. Registration: ClinicalTrials.Gov 15-0479.

Indexed as

Heart Disease Risk FactorsAdultAgedAge FactorsCardiovascular DiseasesFemaleHumansMaleMiddle AgedNorth CarolinaPrimary Health CareQuality ImprovementRisk FactorsRisk Reduction BehaviorSex FactorsSocioeconomic FactorsCVD risk reductionpractice facilitationprimary careprimary preventionquality improvementrisk stratificationstatins

Identifiers

PMID33047340
PMCPMC7704467
OpenAlexW3091677602

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.