Jones, Julia L ORCID: 0000-0002-1266-4731, Simons, Koen, Manski-Nankervis, Jo-Anne, Lumsden, Natalie G, Fernando, Sanduni, de Courten, Maximilian ORCID: 0000-0001-9997-9359, Cox, Nicholas, Hamblin, Peter Shane, Janus, Edward D and Nelson, Craig L (2023) Chronic disease IMPACT (chronic disease early detection and improved management in primary care project): an Australian stepped wedge cluster randomised trial. Digital Health, 9. ISSN 2055-2076

Abstract

Background: Interrelated chronic vascular diseases (chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease (CVD)) are common with high morbidity and mortality. This study aimed to assess if an electronic-technology-based quality improvement intervention in primary care could improve detection and management of people with and at risk of these diseases. Methods: Stepped-wedge trial with practices randomised to commence intervention in one of five 16-week periods. Intervention included (1) electronic-technology tool extracting data from general practice electronic medical records and generating graphs and lists for audit; (2) education regarding chronic disease and the electronic-technology tool; (3) assistance with quality improvement audit plan development, benchmarking, monitoring and support. De-identified data analysis using R 3.5.1 conducted using Bayesian generalised linear mixed model with practice and time-specific random intercepts. Results: At baseline, eight included practices had 37,946 active patients (attending practice ≥3 times within 2 years) aged ≥18 years. Intervention was associated with increased OR (95% CI) for: kidney health checks (estimated glomerular filtration rate, urine albumin:creatinine ratio (uACR) and blood pressure) in those at risk 1.34 (1.26–1.42); coded diagnosis of CKD 1.18 (1.09–1.27); T2D diagnostic testing (fasting glucose or HbA1c) in those at risk 1.15 (1.08–1.23); uACR in patients with T2D 1.78 (1.56–2.05). Documented eye checks within recommended frequency in patients with T2D decreased 0.85 (0.77–0.96). There were no significant changes in other assessed variables. Conclusions: This electronic-technology-based intervention in primary care has potential to help translate guidelines into practice but requires further refining to achieve widespread improvements across the interrelated chronic vascular diseases.

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