title: Adoption of cardiovascular risk reduction guidelines: a cluster-randomized trial.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children.
  
  
  METHODS
  Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared.
  
  
  RESULTS
  The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01).
  
  
  CONCLUSIONS
  Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.
authors.affiliation: RTI International Waltham, Massachusetts; klabresh@rti.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: LaBresh
authors.affiliation: Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, Illinois; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
authors.forename: Adolfo J
authors.initials: AJ
authors.lastname: Ariza
authors.affiliation: Brody School of Medicine, Departments of Pediatrics and Public Health, East Carolina University, Greenville North Carolina;
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lazorick
authors.affiliation: RTI International Waltham, Massachusetts;
authors.forename: Robert D
authors.initials: RD
authors.lastname: Furberg
authors.affiliation: Brody School of Medicine, Departments of Pediatrics and Public Health, East Carolina University, Greenville North Carolina; Public Health Institute, Research and Evaluation Section Nutrition Education and Obesity Prevention Branch, California Department of Public Health, Sacramento, California; and.
authors.forename: Lauren
authors.initials: L
authors.lastname: Whetstone
authors.affiliation: RTI International Waltham, Massachusetts;
authors.forename: Connie
authors.initials: C
authors.lastname: Hobbs
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Janet
authors.initials: J
authors.lastname: de Jesus
authors.affiliation: Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
authors.forename: Ilse G
authors.initials: IG
authors.lastname: Salinas
authors.affiliation: RTI International Waltham, Massachusetts;
authors.forename: Randall H
authors.initials: RH
authors.lastname: Bender
authors.affiliation: Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, Illinois;
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Binns
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D040242:Risk Reduction Behavior
keywords: cardiovascular disorders; children; cluster randomized trial; guideline implementation; prevention; quality improvement