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Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records

Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records
Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records
Background and Purpose: The aim of this study was to valuate whether the remote introduction of electronic decision
support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using electronic health records.

Methods: Family practices were recruited from the UK Clinical Practice Research Datalink and allocated to intervention and control trial arms by minimization. Remotely installed, electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome. Outcome data from electronic health records were analyzed using marginal models.

Results: There were 106 Clinical Practice Research Datalink family practices allocated (intervention, 53; control, 53), with 11 391 (control, 5516; intervention, 5875)participants with acute stroke ever diagnosed. Participants at trial practices had similar characteristics as 47 887 patients with stroke at nontrial practices. During the intervention period, blood pressure values were recorded in the electronic health records for 90% and cholesterol values for 84% of participants. After intervention, the latest mean systolic blood pressure was 131.7 (SD, 16.8) mm Hg in the control trial arm and 131.4 (16.7) mm Hg in the intervention trial arm, and adjusted mean difference was ?0.56 mm Hg (95% confidence interval, ?1.38 to 0.26; P=0.183). The financial cost of the trial was approximately US $22 per participant, or US $2400 per family practice allocated.

Conclusions: Large pragmatic intervention studies may be implemented at low cost by using electronic health records.
The intervention used in this trial was not found to be effective, and further research is needed to develop more effective intervention strategies
blood pressure, cholesterol, electronic health records, intervention studies, secondary prevention, stroke
0039-2499
2066-2071
Dregan, A.
392a61a5-b1a1-4d41-87c3-18e3984b10b2
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
McDermott, L.
5e895229-decd-4a30-8d08-dd9cc5b8f443
McCann, G.
3876a282-f79e-44c1-a109-ae99bf8a8c70
Ashworth, M.
a70c436c-8405-4518-806d-1003fd9d5386
Charlton, J.
0177b4df-4db7-4de8-b4bd-143b8e3ba169
Wolfe, C.D.A.
026ef4bf-fc20-4a9b-bf3c-02271fee8694
Rudd, A.
4984b58f-2169-4836-8140-f08cacdbb14d
Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Gulliford, M.C.
443b6214-b206-405a-b13b-b93541e2defc
Meredith, S.
84f00dc2-451c-438e-9fc5-6edf7259d0bb
Kerry, S.
45167362-3df0-427c-88db-045cb9e8c63c
Murray, E.
7bf1a8d5-dff0-4748-8060-e96377a70216
Mant, J.
6a0e609a-4737-49ca-b0df-ae8d53e810e1
Robson, J.
43500b5e-3774-4c38-8a5d-47c2f73b127c
Haywood, A.
42f51ce3-67c3-4b84-ad77-3dfb8efa272c
Pursani, N.
8069fa46-517b-4658-ba1a-99d220514a6b
Dregan, A.
392a61a5-b1a1-4d41-87c3-18e3984b10b2
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
McDermott, L.
5e895229-decd-4a30-8d08-dd9cc5b8f443
McCann, G.
3876a282-f79e-44c1-a109-ae99bf8a8c70
Ashworth, M.
a70c436c-8405-4518-806d-1003fd9d5386
Charlton, J.
0177b4df-4db7-4de8-b4bd-143b8e3ba169
Wolfe, C.D.A.
026ef4bf-fc20-4a9b-bf3c-02271fee8694
Rudd, A.
4984b58f-2169-4836-8140-f08cacdbb14d
Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Gulliford, M.C.
443b6214-b206-405a-b13b-b93541e2defc
Meredith, S.
84f00dc2-451c-438e-9fc5-6edf7259d0bb
Kerry, S.
45167362-3df0-427c-88db-045cb9e8c63c
Murray, E.
7bf1a8d5-dff0-4748-8060-e96377a70216
Mant, J.
6a0e609a-4737-49ca-b0df-ae8d53e810e1
Robson, J.
43500b5e-3774-4c38-8a5d-47c2f73b127c
Haywood, A.
42f51ce3-67c3-4b84-ad77-3dfb8efa272c
Pursani, N.
8069fa46-517b-4658-ba1a-99d220514a6b

Dregan, A., van Staa, T.P., McDermott, L., McCann, G., Ashworth, M., Charlton, J., Wolfe, C.D.A., Rudd, A., Yardley, L., Gulliford, M.C., Meredith, S., Kerry, S., Murray, E., Mant, J., Robson, J., Haywood, A. and Pursani, N. (2014) Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records. Stroke, 45 (7), 2066-2071. (doi:10.1161/STROKEAHA.114.005713). (PMID:24903985)

Record type: Article

Abstract

Background and Purpose: The aim of this study was to valuate whether the remote introduction of electronic decision
support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using electronic health records.

Methods: Family practices were recruited from the UK Clinical Practice Research Datalink and allocated to intervention and control trial arms by minimization. Remotely installed, electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome. Outcome data from electronic health records were analyzed using marginal models.

Results: There were 106 Clinical Practice Research Datalink family practices allocated (intervention, 53; control, 53), with 11 391 (control, 5516; intervention, 5875)participants with acute stroke ever diagnosed. Participants at trial practices had similar characteristics as 47 887 patients with stroke at nontrial practices. During the intervention period, blood pressure values were recorded in the electronic health records for 90% and cholesterol values for 84% of participants. After intervention, the latest mean systolic blood pressure was 131.7 (SD, 16.8) mm Hg in the control trial arm and 131.4 (16.7) mm Hg in the intervention trial arm, and adjusted mean difference was ?0.56 mm Hg (95% confidence interval, ?1.38 to 0.26; P=0.183). The financial cost of the trial was approximately US $22 per participant, or US $2400 per family practice allocated.

Conclusions: Large pragmatic intervention studies may be implemented at low cost by using electronic health records.
The intervention used in this trial was not found to be effective, and further research is needed to develop more effective intervention strategies

This record has no associated files available for download.

More information

Accepted/In Press date: 28 April 2014
Published date: 5 June 2014
Keywords: blood pressure, cholesterol, electronic health records, intervention studies, secondary prevention, stroke

Identifiers

Local EPrints ID: 379987
URI: http://eprints.soton.ac.uk/id/eprint/379987
ISSN: 0039-2499
PURE UUID: c88cd05a-57fd-4aa2-90a0-6ae44fc75f41
ORCID for L. Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 01 Sep 2015 10:25
Last modified: 15 Mar 2024 03:00

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Contributors

Author: A. Dregan
Author: T.P. van Staa
Author: L. McDermott
Author: G. McCann
Author: M. Ashworth
Author: J. Charlton
Author: C.D.A. Wolfe
Author: A. Rudd
Author: L. Yardley ORCID iD
Author: M.C. Gulliford
Author: S. Meredith
Author: S. Kerry
Author: E. Murray
Author: J. Mant
Author: J. Robson
Author: A. Haywood
Author: N. Pursani

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