title: Value of a facilitated quality improvement initiative on cardiovascular disease risk: findings from an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL).
abstract: OBJECTIVE
  In the United States, cardiovascular disease (CVD) is the leading cause of death. The US Centers for Disease Control and Prevention contracted an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL) programme as part of its effort to identify strategies to address CVD risk factors.
  
  
  METHODS
  This study analysed patient-level data from 7527 patients in 43 primary care practices. The researchers assessed average change in control rates for CVD-related measures across practices, and then across patients between baseline and a patient's last visit during the practice's tenure in the programme (referred to as 'end line') using repeated measures analysis of variance and random effects generalized least squares, respectively.
  
  
  RESULTS
  Among non-diabetic patients, there were significant increases in control rates for overall blood pressure (74.3% to 78.0%, P = 0.0002), systolic blood pressure (70.3% to 80.6%, P = 0.0099), diastolic blood pressure (90.1% to 92.7%, P = 0.0001) and low-density lipoprotein (LDL; 48.6% to 53.1%, P = 0.0001) between baseline and end line. Among diabetic patients, there was a significant increase in diastolic blood pressure control (59.8% to 61.9%, P = 0.0141). While continuous CVD-related outcomes show an overall trend between baseline and end line, patients with uncontrolled measures at baseline showed a decrease between baseline and end line relative to their counterparts who were controlled at baseline.
  
  
  CONCLUSIONS
  Findings from the AT GOAL evaluation support the value of a facilitated quality improvement (QI) initiative on managing CVD risk.
authors.affiliation: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Losby
authors.affiliation: ICF International, Atlanta, GA, USA.
authors.forename: Thearis A
authors.initials: TA
authors.lastname: Osuji
authors.affiliation: ICF International, Atlanta, GA, USA.
authors.forename: Marnie J
authors.initials: MJ
authors.lastname: House
authors.affiliation: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Davis
authors.affiliation: ICF International, Atlanta, GA, USA.
authors.forename: Simone Peart
authors.initials: SP
authors.lastname: Boyce
authors.affiliation: ICF International, Atlanta, GA, USA.
authors.forename: Michael Canter
authors.initials: MC
authors.lastname: Greenberg
authors.affiliation: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Whitehill
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004502:Education, Medical, Continuing; D006442:Glycated Hemoglobin; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration*; D058996:Quality Improvement; D012307:Risk Factors; D014481:United States; D044465:White People; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: cardiovascular outcomes; diabetes mellitus; patient care management; primary health care; programme evaluation; quality improvement