Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Sep;134(3):e732-8.
doi: 10.1542/peds.2014-0876.

Adoption of cardiovascular risk reduction guidelines: a cluster-randomized trial

Kenneth A LaBresh  1 , Adolfo J Ariza  2 , Suzanne Lazorick  3 , Robert D Furberg  4 , Lauren Whetstone  5 , Connie Hobbs  4 , Janet de Jesus  6 , Ilse G Salinas  7 , Randall H Bender  4 , Helen J Binns  8
Affiliations
Randomized Controlled Trial

Adoption of cardiovascular risk reduction guidelines: a cluster-randomized trial

Kenneth A LaBresh et al. Pediatrics. 2014 Sep.

Abstract

Background and objectives: Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children.

Methods: Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared.

Results: The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01).

Conclusions: Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.

Trial registration: ClinicalTrials.gov NCT01893593.

Keywords: cardiovascular disorders; children; cluster randomized trial; guideline implementation; prevention; quality improvement.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
A, Composite measure results overall and according to condition. B, Improvement in the intervention group compared with the control group at baseline and follow-up. aSignificant improvement compared with the control group.
See this image and copyright information in PMC

References

    1. Birch LL. Development of food preferences. Annu Rev Nutr. 1999;19:41–62 - PubMed
    1. Barker DJP. Mothers, Babies and Health in Later Life. 2nd ed. Edinburgh, Scotland: Churchill Livingstone; 1998
    1. Guyer B, Ma S, Grason H, et al. . Early childhood health promotion and its life course health consequences. Acad Pediatr. 2009;9(3):142–149, e1–e71 - PubMed
    1. Berenson GS, Srinivasan SR, Bao W, Newman WP, III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338(23):1650–1656 - PubMed
    1. Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. Pediatrics. 2007;120(2):340–345 - PubMed

Publication types

Associated data