title: Effectiveness of improvement plans in primary care practice accreditation: a clustered randomized trial.
abstract: BACKGROUND
  Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM).
  
  
  METHODS
  A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22) were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23) could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project.
  
  
  RESULTS
  No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale.
  
  
  CONCLUSIONS
  The focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes. ClinicalTrials.gov NCT00791362.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Elvira
authors.initials: E
authors.lastname: Nouwens
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.affiliation: Dutch College of General Practitioners, Utrecht, The Netherlands.
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000068:Accreditation / Q000379:methods*; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D058996:Quality Improvement; D012308:Risk Management; D016896:Treatment Outcome