title: Evaluation of the implementation of an integrated primary care network for prevention and management of cardiometabolic risk in Montréal.
abstract: BACKGROUND
  The goal of this project is to evaluate the implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk (PCMR). The intervention is based on the Chronic Care Model. The study will evaluate the implementation of the PCMR in 6 of the 12 health and social services centres (CSSS) in Montréal, and the effects of the PCMR on patients and the practice of their primary care physicians up to 40 months following implementation, as well as the sustainability of the program. Objectives are: 1-to evaluate the effects of the PCMR and their persistence on patients registered in the program and the practice of their primary care physicians, by implementation site and degree of exposure to the program; 2-to assess the degree of implementation of PCMR in each CSSS territory and identify related contextual factors; 3-to establish the relationships between the effects observed, the degree of PCMR implementation and the related contextual factors; 4-to assess the impact of the PCMR on strengthening local services networks.
  
  
  METHODS
  The evaluation will use a mixed design that includes two complementary research strategies. The first strategy is similar to a quasi-experimental "before-after" design, based on a quantitative approach; it will look at the program's effects and their variations among the six territories. The effects analysis will use data from a clinical database and from questionnaires completed by participating patients and physicians. Over 3000 patients will be recruited. The second strategy corresponds to a multiple case study approach, where each of the six CSSS constitutes a case. With this strategy, qualitative methods will set out the context of implementation using data from semi-structured interviews with program managers. The quantitative data will be analyzed using linear or multilevel models complemented with an interpretive approach to qualitative data analysis.
  
  
  CONCLUSIONS
  Our study will identify contextual factors associated with the effectiveness, successful implementation and sustainability of such a program. The contextual information will enable us to extrapolate our results to other contexts with similar conditions.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01326130.
authors.affiliation: Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Canada. sprovost@santepub-mtl.qc.ca
authors.forename: Sylvie
authors.initials: S
authors.lastname: Provost
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
authors.forename: Pierre
authors.initials: P
authors.lastname: Tousignant
authors.forename: Marjolaine
authors.initials: M
authors.lastname: Hamel
authors.forename: Roxane Borgès
authors.initials: RB
authors.lastname: Da Silva
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy; D002908:Chronic Disease / Q000517:prevention & control*; D019058:Community Networks / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D006284:Health Plan Implementation; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D009937:Organizational Objectives; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods*; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods; D011792:Quebec; D012107:Research Design; D011795:Surveys and Questionnaires
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