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Multicenter Study
. 2006 May 31;37(9):498-503.
doi: 10.1157/13089094.

[Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients]

[Article in Spanish]
Manuel A Gómez Marcos  1 , Luis García Ortiz, Luis Javier González Elena, Angel Sánchez Rodríguez
Affiliations
Multicenter Study

[Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients]

[Article in Spanish]
Manuel A Gómez Marcos et al. Aten Primaria. .

Abstract
in English, Spanish

Objective: To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension.

Design: Quasi-experimental study.

Setting: Primary care. Two urban health centres.

Participants: A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group).

Interventions: The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines.

Main measurements: Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project.

Results: Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk.

Conclusions: The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.

Objetivo: Evaluar la efectividad de una intervención sobre los profesionales sanitarios basada en la metodología de mejora de la calidad mediante la reducción del riesgo cardiovascular en pacientes con hipertensión.

Diseño: Estudio de evaluación de calidad con intervención no aleatoria.

Emplazamiento: Atención primaria. Dos centros de salud urbanos.

Participantes: Muestreo aleatorio estratificado de 1.000 hipertensos de los dos centros de salud. Un centro (500) fue asignado para recibir una intervención de mejora de calidad y el otro (500), la atención habitual (control).

Intervenciones: La intervención de mejora de calidad consistió en un programa combinado para el personal sanitario que incluyó: audit, feedback, sesiones de formación e implementación de guías clínicas.

Mediciones principales: Riesgo coronario determinado mediante la escala de Framingham y riesgo de mortalidad cardiovascular valorado con la escala del proyecto SCORE.

Resultados: El riesgo coronario absoluto decreció del 16,94% (intervalo de confianza [IC] del 95%, 15,92-17,66) al 13,81% (IC del 95%, 13,09-14,52) (p < 0,001) en el grupo de intervención, sin diferencias en el grupo control, del 17,63% (IC del 95%, 16,68-18,53) al 16,82% (IC del 95%, 15,91-17,74). El efecto logrado por la intervención fue un descenso del riesgo de 2,28 puntos porcentuales (IC del 95%, 1,35-3,21) (p < 0,001). El riesgo de mortalidad cardiovascular decreció del 2,48% (IC del 95%, 2,35-2,62) al 2,19% (IC del 95%, 2,07-2,31) (p < 0,001) en el grupo de intervención, sin diferencias en el grupo control del 2,45% (IC del 95%, 2,30-2,59) al 2,52% (IC del 95%, 2,38-2,66). El efecto logrado por la intervención fue un descenso del riesgo de 0,36 puntos porcentuales (IC del 95%, 0,05-0,73) (p < 0,001).

Conclusiones: La intervención de mejora de calidad ha sido efectiva en el descenso del riesgo coronario y del riesgo de mortalidad cardiovascular en pacientes hipertensos.

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