title: Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care.
abstract: BACKGROUND
  There is a need to find innovative approaches for translating best practices for chronic disease care into daily primary care practice routines. Primary care plays a crucial role in the prevention and management of cardiovascular disease. There is, however, a substantive care gap, and many challenges exist in implementing evidence-based care. The Improved Delivery of Cardiovascular Care (IDOCC) project is a pragmatic trial designed to improve the delivery of evidence-based care for the prevention and management of cardiovascular disease in primary care practices using practice outreach facilitation.
  
  
  METHODS
  The IDOCC project is a stepped-wedge cluster randomized control trial in which Practice Outreach Facilitators work with primary care practices to improve cardiovascular disease prevention and management for patients at highest risk. Primary care practices in a large health region in Eastern Ontario, Canada, were eligible to participate. The intervention consists of regular monthly meetings with the Practice Outreach Facilitator over a one- to two-year period. Starting with audit and feedback, consensus building, and goal setting, the practices are supported in changing practice behavior by incorporating chronic care model elements. These elements include (a) evidence-based decision support for providers, (b) delivery system redesign for practices, (c) enhanced self-management support tools provided to practices to help them engage patients, and (d) increased community resource linkages for practices to enhance referral of patients. The primary outcome is a composite score measured at the level of the patient to represent each practice's adherence to evidence-based guidelines for cardiovascular care. Qualitative analysis of the Practice Outreach Facilitators' written narratives of their ongoing practice interactions will be done. These textual analyses will add further insight into understanding critical factors impacting project implementation.
  
  
  CONCLUSIONS
  This pragmatic, stepped-wedge randomized controlled trial with both quantitative and process evaluations demonstrates innovative methods of implementing large-scale quality improvement and evidence-based approaches to care delivery. This is the first Canadian study to examine the impact of a large-scale multifaceted cardiovascular quality-improvement program in primary care. It is anticipated that through the evaluation of IDOCC, we will demonstrate an effective, practical, and sustainable means of improving the cardiovascular health of patients across Canada.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00574808.
authors.affiliation: C. T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada. cliddy@bruyere.org
authors.forename: Clare
authors.initials: C
authors.lastname: Liddy
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.forename: George
authors.initials: G
authors.lastname: Wells
authors.forename: Catherine Deri
authors.initials: CD
authors.lastname: Armstrong
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.forename: Simone
authors.initials: S
authors.lastname: Dahrouge
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.forename: Liesha
authors.initials: L
authors.lastname: Mayo-Bruinsma
authors.forename: Jatinderpreet
authors.initials: J
authors.lastname: Singh
authors.forename: Alex
authors.initials: A
authors.lastname: Cornett
mesh_terms: D002318:Cardiovascular Diseases / Q000628:therapy*; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000592:standards*; D055317:Evidence-Based Practice; D006801:Humans; D017146:Models, Organizational; D009864:Ontario; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011786:Quality Control; D011787:Quality of Health Care; D012044:Regression Analysis; D012307:Risk Factors