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Improving Patient Care |

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

Steven Ornstein, MD; Ruth G. Jenkins, MS; Paul J. Nietert, PhD; Chris Feifer, DrPH; Loraine F. Roylance, BS; Lynne Nemeth, RN, MS; Sarah Corley, MD; Lori Dickerson, PharmD; W. David Bradford, PhD; and Cara Litvin, MD
[+] Article and Author Information

From Medical University of South Carolina, Charleston, South Carolina, and University of Southern California, Los Angeles, California.


Grant Support: By the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Public Health Service (grant no. 1 U18 HS11132-01).

Potential Financial Conflicts of Interest:Consultancies: S. Ornstein, C. Feifer, L. Dickerson, C. Litvin (Physician MicroSystems, Inc.); Grants received: S. Ornstein (Physician MicroSystems, Inc.); Royalties: S. Ornstein (Physician MicroSystems, Inc.).

Requests for Single Reprints: Steven Ornstein, MD, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425; e-mail, ornstesm@musc.edu.

Current Author Addresses: Drs. Ornstein and Litvin, Ms. Jenkins, and Ms. Roylance: Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425.

Dr. Nietert: Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425.

Dr. Feifer: Department of Family Medicine, University of Southern California, 1000 South Fremont Avenue, Building A7, Room 7419, Alhambra, CA 91803.

Ms. Nemeth: Care Management, Research/Evaluation, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425.

Dr. Corley: Internal Medicine Associates, 3715 Moss Drive, Annandale, VA 22003.

Dr. Dickerson: University Family Medicine, Medical University of South Carolina, 9298 Medical Plaza Drive North, Charleston, SC 29408.

Dr. Bradford: Health Administration and Policy, Medical University of South Carolina, 19 Hagood Avenue, Room 401, Charleston, SC 29425.


Ann Intern Med. 2004;141(7):523-532. doi:10.7326/0003-4819-141-7-200410050-00008
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Our primary finding is that a multimethod quality improvement intervention—adding practice site visits and network meetings—was only marginally more effective than performance reports alone for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke in primary care practices that use an electronic medical record. However, equally important is our finding that substantial improvement occurred in both groups in analyses at the practice and patient level.

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Appendix Figure.
Sample practice report for blood pressure in coronary heart disease.

JNC VI = Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

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Summary for Patients

A Comparison of Different Programs To Improve Preventive Care for Cardiovascular Conditions

The summary below is from the full report titled “A Multimethod Quality Improvement Intervention To Improve Preventive Cardiovascular Care. A Cluster Randomized Trial.” It is in the 5 October 2004 issue of Annals of Internal Medicine (volume 141, pages 523-532). The authors are S. Ornstein, R.G. Jenkins, P.J. Nietert, C. Feifer, L.F. Roylance, L. Nemeth, S. Corley, L. Dickerson, W.D. Bradford, and C. Litvin.

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