title: Effect of an educational toolkit on quality of care: a pragmatic cluster randomized trial.
abstract: BACKGROUND
  Printed educational materials for clinician education are one of the most commonly used approaches for quality improvement. The objective of this pragmatic cluster randomized trial was to evaluate the effectiveness of an educational toolkit focusing on cardiovascular disease screening and risk reduction in people with diabetes.
  
  
  RESULTS
  All 933,789 people aged ≥40 years with diagnosed diabetes in Ontario, Canada were studied using population-level administrative databases, with additional clinical outcome data collected from a random sample of 1,592 high risk patients. Family practices were randomly assigned to receive the educational toolkit in June 2009 (intervention group) or May 2010 (control group). The primary outcome in the administrative data study, death or non-fatal myocardial infarction, occurred in 11,736 (2.5%) patients in the intervention group and 11,536 (2.5%) in the control group (p = 0.77). The primary outcome in the clinical data study, use of a statin, occurred in 700 (88.1%) patients in the intervention group and 725 (90.1%) in the control group (p = 0.26). Pre-specified secondary outcomes, including other clinical events, processes of care, and measures of risk factor control, were also not improved by the intervention. A limitation is the high baseline rate of statin prescribing in this population.
  
  
  CONCLUSIONS
  The educational toolkit did not improve quality of care or cardiovascular outcomes in a population with diabetes. Despite being relatively easy and inexpensive to implement, printed educational materials were not effective. The study highlights the need for a rigorous and scientifically based approach to the development, dissemination, and evaluation of quality improvement interventions.
  
  
  BACKGROUND
  http://www.ClinicalTrials.gov NCT01411865 and NCT01026688.
authors: University of Toronto, Toronto, Ontario, Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada ; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Baiju R
authors: BR
authors: Shah
authors: University of Toronto, Toronto, Ontario, Canada ; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Onil
authors: O
authors: Bhattacharyya
authors: University of Toronto, Toronto, Ontario, Canada ; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Catherine H Y
authors: CH
authors: Yu
authors: University of Toronto, Toronto, Ontario, Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada ; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Muhammad M
authors: MM
authors: Mamdani
authors: University of Toronto, Toronto, Ontario, Canada ; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Janet A
authors: JA
authors: Parsons
authors: University of Toronto, Toronto, Ontario, Canada ; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Sharon E
authors: SE
authors: Straus
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada ; University of Western Ontario, London, Ontario, Canada.
authors: Merrick
authors: M
authors: Zwarenstein
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D009864:Ontario; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome