The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study

doi:10.9778/cmajo.20160139

. 2017 Apr 25;5(2):E315-E321.

doi: 10.9778/cmajo.20160139.

The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study

Jack V Tu¹, Laura C Maclagan¹, Dennis T Ko¹, Clare L Atzema¹, Gillian L Booth¹, Sharon Johnston¹, Karen Tu¹, Douglas S Lee¹, Arlene Bierman¹, Ruth Hall¹, R Sacha Bhatia¹, Andrea S Gershon¹, Sheldon W Tobe¹, Claudia Sanmartin¹, Peter Liu¹, Anna Chu¹; CANHEART Primary Prevention Indicator Expert Panel

Affiliations

Affiliation

¹ Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont.

PMID: 28446446
PMCID: PMC5498313
DOI: 10.9778/cmajo.20160139

The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study

Jack V Tu et al. CMAJ Open. 2017.

. 2017 Apr 25;5(2):E315-E321.

doi: 10.9778/cmajo.20160139.

Authors

Affiliation

¹ Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont.

PMID: 28446446
PMCID: PMC5498313
DOI: 10.9778/cmajo.20160139

Abstract

Background: High-quality ambulatory care can reduce cardiovascular disease risk, but important gaps exist in the provision of cardiovascular preventive care. We sought to develop a set of key performance indicators that can be used to measure and improve cardiovascular care in the primary care setting.

Methods: As part of the Cardiovascular Health in Ambulatory Care Research Team initiative, we established a 14-member multidisciplinary expert panel to develop a set of indicators for measuring primary prevention performance in ambulatory cardiovascular care. We used a 2-stage modified Delphi panel process to rate potential indicators, which were identified from the literature and national cardiovascular organizations. The top-rated indicators were pilot tested to determine their measurement feasibility with the use of data routinely collected in the Canadian health care system.

Results: A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes. The indicators reflect the major cardiovascular risk factors including smoking, obesity, hypertension, diabetes, dyslipidemia and atrial fibrillation. All indicators were determined to be amenable to measurement with the use of population-based administrative (physician claims, hospital admission, laboratory, medication), survey or electronic medical record databases.

Interpretation: The Cardiovascular Health in Ambulatory Care Research Team indicators of primary prevention performance provide a framework for the measurement of cardiovascular primary prevention efforts in Canada. The indicators may be used by clinicians, researchers and policy-makers interested in measuring and improving the prevention of cardiovascular disease in ambulatory care settings.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Flow chart of CANHEART primary prevention performance indicator selection process.

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References

1. Braga M, Casanova A, Teoh H, et al. Diabetes Registry to Improve Vascular Events (DRIVE) Investigators. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada. Can J Cardiol. 2010;26:297–302. - PMC - PubMed
1. Hennessy DA, Tanuseputro P, Tuna M, et al. Population health impact of statin treatment in Canada. Health Rep. 2016;27:20–8. - PubMed
1. Joffres MR, Hamet P, MacLean DR, et al. Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens. 2001;14:1099–105. - PubMed
1. Tu JV, Chu A, Donovan LR, et al. The Cardiovascular Health in Ambulatory Care Research Team (CANHEART): using big data to measure and improve cardiovascular health and healthcare services. Circ Cardiovasc Qual Outcomes. 2015;8:204–12. - PubMed
1. Pan-Canadian primary healthcare indicators, Report 1, Volume 1. Ottawa: Canadian Institute for Health Information. 2006.

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[1] Braga M, Casanova A, Teoh H, et al. Diabetes Registry to Improve Vascular Events (DRIVE) Investigators. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada. Can J Cardiol. 2010;26:297–302. - PMC - PubMed

[2] Braga M, Casanova A, Teoh H, et al. Diabetes Registry to Improve Vascular Events (DRIVE) Investigators. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada. Can J Cardiol. 2010;26:297–302. - PMC - PubMed

[3] Hennessy DA, Tanuseputro P, Tuna M, et al. Population health impact of statin treatment in Canada. Health Rep. 2016;27:20–8. - PubMed

[4] Hennessy DA, Tanuseputro P, Tuna M, et al. Population health impact of statin treatment in Canada. Health Rep. 2016;27:20–8. - PubMed

[5] Joffres MR, Hamet P, MacLean DR, et al. Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens. 2001;14:1099–105. - PubMed

[6] Joffres MR, Hamet P, MacLean DR, et al. Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens. 2001;14:1099–105. - PubMed

[7] Tu JV, Chu A, Donovan LR, et al. The Cardiovascular Health in Ambulatory Care Research Team (CANHEART): using big data to measure and improve cardiovascular health and healthcare services. Circ Cardiovasc Qual Outcomes. 2015;8:204–12. - PubMed

[8] Tu JV, Chu A, Donovan LR, et al. The Cardiovascular Health in Ambulatory Care Research Team (CANHEART): using big data to measure and improve cardiovascular health and healthcare services. Circ Cardiovasc Qual Outcomes. 2015;8:204–12. - PubMed

[9] Pan-Canadian primary healthcare indicators, Report 1, Volume 1. Ottawa: Canadian Institute for Health Information. 2006.

[10] Pan-Canadian primary healthcare indicators, Report 1, Volume 1. Ottawa: Canadian Institute for Health Information. 2006.

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The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study

Affiliation

The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study

Authors

Affiliation

Abstract

Conflict of interest statement

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