title: Improving quality of organizing cardiovascular preventive care in general practice by outreach visitors: a randomized controlled trial.
abstract: BACKGROUND
  Adequate care for patients with cardiovascular risks requires an adequate practice organization. Educational outreach visits are a promising approach to modifying professional behavior. We aimed to assess whether the quality of cardiovascular preventive care in general practice can be improved through a comprehensive intervention implemented by an educational outreach visitor.
  
  
  METHODS
  After baseline measurements, general practices (n = 124) in the southern half of The Netherlands were randomly allocated to either intervention or control group. The intervention, based on the educational outreach model, comprised 15 practice visits over a period of 21 months and addressed a large number of issues around task delegation, availability of instruments and patient leaflets, record-keeping, and follow-up routines. Twenty-one months after the start of the intervention, postintervention measurements were performed. The difference between ideal and actual practice in each aspect of organizing preventive care was defined as a deficiency score. Primary outcome measure was the difference in deficiency scores before and after the intervention.
  
  
  RESULTS
  All practices completed both baseline and postintervention measurements. The difference in change between intervention and control group adjusted for baseline was statistically significant (P < 0.001) for each aspect of organizing preventive care. The largest absolute improvement was found for the number of preventive tasks performed by the practice assistant.
  
  
  CONCLUSIONS
  This study showed that a comprehensive intervention implemented by outreach visitors was effective in improving organization of cardiovascular preventive care in general practice.
authors.affiliation: Department of General Practice, Erasmus University Rotterdam, The Netherlands.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Lobo
authors.forename: Bernard D
authors.initials: BD
authors.lastname: Frijling
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: Roos M D
authors.initials: RM
authors.lastname: Bernsen
authors.forename: Jozé C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Ad
authors.initials: A
authors.lastname: Prins
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019468:Disease Management; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice / Q000193:education* / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009936:Organizational Innovation; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care; D018709:Statistics, Nonparametric