Chronic disease IMPACT (chronic disease early detection and improved management in primary care project): An Australian stepped wedge cluster randomised trial

Julia L Jones; Koen Simons; Jo-Anne Manski-Nankervis; Natalie G Lumsden; Sanduni Fernando; Maximilian P de Courten; Nicholas Cox; Peter Shane Hamblin; Edward D Janus; Craig L Nelson

doi:10.1177/20552076231194948

Chronic disease IMPACT (chronic disease early detection and improved management in primary care project): An Australian stepped wedge cluster randomised trial

Digit Health. 2023 Aug 14:9:20552076231194948. doi: 10.1177/20552076231194948. eCollection 2023 Jan-Dec.

Authors

Julia L Jones^{1

2

3}, Koen Simons^{4

5}, Jo-Anne Manski-Nankervis⁶, Natalie G Lumsden^{1

2

6}, Sanduni Fernando¹, Maximilian P de Courten^{7

8}, Nicholas Cox^{2

8

9}, Peter Shane Hamblin^{2

3

10}, Edward D Janus^{2

3

11}, Craig L Nelson^{1

2

3}

Affiliations

¹ Nephrology, Western Health, Melbourne, Australia.
² Western Health Chronic Disease Alliance, Melbourne, Australia.
³ Department of Medicine, The University of Melbourne, Melbourne, Australia.
⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
⁵ Office for Research, Western Health, Melbourne, Australia.
⁶ Department of General Practice, The University of Melbourne, Melbourne, Australia.
⁷ Mitchell Institute for Education and Health Policy, Melbourne, Australia.
⁸ Centre for Chronic Disease, Victoria University, Melbourne, Australia.
⁹ Cardiology, Western Health, Melbourne, Australia.
¹⁰ Endocrinology and Diabetes, Western Health, Melbourne, Australia.
¹¹ Medicine, Western Health, Melbourne, Australia.

Abstract

Background: Interrelated chronic vascular diseases (chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease (CVD)) are common with high morbidity and mortality. This study aimed to assess if an electronic-technology-based quality improvement intervention in primary care could improve detection and management of people with and at risk of these diseases.

Methods: Stepped-wedge trial with practices randomised to commence intervention in one of five 16-week periods. Intervention included (1) electronic-technology tool extracting data from general practice electronic medical records and generating graphs and lists for audit; (2) education regarding chronic disease and the electronic-technology tool; (3) assistance with quality improvement audit plan development, benchmarking, monitoring and support. De-identified data analysis using R 3.5.1 conducted using Bayesian generalised linear mixed model with practice and time-specific random intercepts.

Results: At baseline, eight included practices had 37,946 active patients (attending practice ≥3 times within 2 years) aged ≥18 years. Intervention was associated with increased OR (95% CI) for: kidney health checks (estimated glomerular filtration rate, urine albumin:creatinine ratio (uACR) and blood pressure) in those at risk 1.34 (1.26-1.42); coded diagnosis of CKD 1.18 (1.09-1.27); T2D diagnostic testing (fasting glucose or HbA1c) in those at risk 1.15 (1.08-1.23); uACR in patients with T2D 1.78 (1.56-2.05). Documented eye checks within recommended frequency in patients with T2D decreased 0.85 (0.77-0.96). There were no significant changes in other assessed variables.

Conclusions: This electronic-technology-based intervention in primary care has potential to help translate guidelines into practice but requires further refining to achieve widespread improvements across the interrelated chronic vascular diseases.

Keywords: Electronic medical records; cardiovascular disease; chronic kidney disease; diabetes mellitus; general practice.