Effectiveness of a Quality Improvement Intervention in Reducing Cardiovascular Risk in Hypertensive Patients

Abstract

To evaluate the effect of a quality improvement intervention on the reduction of cardiovascular risk in patients with hypertension. Quasi-experimental study involving two primary care centres. One centre was assigned to implement a quality improvement intervention (n = 482 patients), while at the other center "usual care" procedures were followed (control group, n = 360 patients). The quality improvement intervention consisted of a combined program designed for the medical staff and comprising audit, feedback, training sessions and implementation of clinical practice guidelines during 6 months. The main outcome measures were blood pressure, lipid levels, diabetes, smoking and cardiovascular risk. These values were compared before the intervention and after one year. The baseline characteristics of the patients were similar in both groups. Absolute cardiovascular risk decreased from 15.85% to 14.36% (P< .05) in the intervention group, and no significant change was observed in the control group (15.17% to 15.76%). The intervention led to a 2.07% decrease in cardiovascular risk (95%CI, 1.21-2.93; P< .05). The percentage of patients with high cardiovascular risk (> 20% at 10 years) decreased in the intervention group from 30% to 25%, and increased in the control group from 28% to 30%. Relative cardiovascular risk decreased from 2.03 to 1.75 (P< .05) in the intervention group, and from 1.98 to 1.92 (P> .05) in the control group. The intervention thus led to a 0.25 decrease in relative risk (95%CI: 0.14-0.35). Absolute and relative cardiovascular risk in patients with hypertension was reduced by a quality improvement intervention. The percentage of patients with high cardiovascular risk was also reduced.