title: Effectiveness and efficiency of a practice accreditation program on cardiovascular risk management in primary care: study protocol of a clustered randomized trial.
abstract: BACKGROUND
  Cardiovascular risk management is largely provided in primary healthcare, but not all patients with established cardiovascular diseases receive preventive treatment as recommended. Accreditation of healthcare organizations has been introduced across the world with a range of aims, including the improvement of clinical processes and outcomes. The Dutch College of General Practitioners has launched a program for accreditation of primary care practices, which focuses on chronic illness care. This study aims to determine the effectiveness and efficiency of a practice accreditation program, focusing on patients with established cardiovascular diseases.
  
  
  METHODS
  We have planned a two-arm cluster randomized trial with a block design. Seventy primary care practices will be recruited from those who volunteer to participate in the practice accreditation program. Primary care practices will be the unit of randomization. A computer list of random numbers will be generated by an independent statistician. The intervention group (n = 35 practices) will be instructed to focus improvement on cardiovascular risk management. The control group will be instructed to focus improvement on other domains in the first year of the program. Baseline and follow-up measurements at 12 months after receiving the accreditation certificate are based on a standardized version of the audit in the practice accreditation program. Primary outcomes include controlled blood pressure, serum cholesterol, and prescription of recommended preventive medication. Secondary outcomes are 15 process indicators and two outcome indicators of cardiovascular risk management, self-reported achievement of improvement goals and perceived unintended consequences. The intention to treat analysis is statistically powered to detect a difference of 10% on primary outcomes. The economic evaluation aims to determine the efficiency of the program and investigates the relationship between costs, performance indicators, and accreditation.
  
  
  CONCLUSIONS
  It is important to gain more information about the effectiveness and efficiency of the practice accreditation program to assess if participation is worthwhile regarding the quality of cardiovascular risk management. The results of this study will help to develop the practice accreditation program for primary care practices.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101/Geert Grooteplein 21, 114 IQ healthcare, Nijmegen, HB 6500, The Netherlands. e.nouwens@iq.umcn.nl
authors.forename: Elvira
authors.initials: E
authors.lastname: Nouwens
authors.forename: Jan
authors.initials: J
authors.lastname: Van Lieshout
authors.forename: Eddy
authors.initials: E
authors.lastname: Adang
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000068:Accreditation / Q000458:organization & administration*; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000628:therapy*; D019090:Case Management / Q000458:organization & administration* / Q000592:standards; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D015438:Health Behavior; D006801:Humans; D009426:Netherlands; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D002784:Cholesterol