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

Health Serv Res. 2020 Dec;55(6):944-953. doi: 10.1111/1475-6773.13571. Epub 2020 Oct 13.


Objective: To 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 setting: A 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 design: We 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 methods: Data extracts were securely transferred from practices on a nightly basis from their EHR to the research team registry.

Principle findings: ASCVD 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.

Conclusion: A 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.

Keywords: CVD risk reduction; practice facilitation; primary care; primary prevention; quality improvement; risk stratification; statins.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cardiovascular Diseases / prevention & control*
  • Female
  • Heart Disease Risk Factors*
  • Humans
  • Male
  • Middle Aged
  • North Carolina
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards
  • Quality Improvement / organization & administration*
  • Risk Factors
  • Risk Reduction Behavior
  • Sex Factors
  • Socioeconomic Factors
  • Time Factors