Effectiveness of Data-Driven Quality Improvement on Hospitalizations and Health Outcomes for People With Coronary Heart Disease in Primary Care (QUEL): A Cluster Randomized Controlled Trial With 24-Month Follow-Up
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: This trial aimed to test the effectiveness of a data-driven quality improvement program in primary care on cardiovascular hospitalizations, major adverse cardiovascular events (MACE), risk factor profiles, and medication prescriptions at 24 months in people with coronary heart disease (CHD) compared with standard care. METHODS: A single-blind, cluster randomized controlled trial recruiting Australian primary care practices (2019-2022) was conducted. Practices using compliant data extraction software and having ≥200 adult patients annually with CHD were the units of randomization, and adults with CHD (who visited their general practitioner in the past 12 months) were the units of analysis. Practices were randomized to intervention (12-month data-driven quality improvement including benchmarking, monthly reporting, and improvement planning) or control (standard care). The primary outcome was the proportion of participants who had unplanned cardiovascular disease hospitalizations at 24 months. Secondary outcomes were MACE, medication prescriptions, risk factor targets, and management planning. Data were extracted from electronic records linked to administrative data. RESULTS: A total of 51 primary care practices participated, resulting in a patient cohort of 7864. The mean age of the patient cohort was 71.9 (±11.8) years, 68% were men, and 24% had a prior myocardial infarction. At 24 months, there was no significant difference between the groups for unplanned cardiovascular disease hospitalizations (relative risk, 0.91 [95% CI, 0.75-1.10]; MACE, 0.81 [95% CI, 0.61-1.07]; prescription of antiplatelet, 0.94 [95% CI, 0.79-1.13]), statin, 1.03 [95% CI, 0.97-1.09], angiotensin-converting enzyme or angiotensin receptor blocker, 1.00 [95% CI, 0.93-1.07]; risk factor targets for low-density lipoprotein cholesterol, 0.99 [95% CI, 0.86-1.13], systolic blood pressure, 0.97 [95% CI, 0.87-1.09], or smoking, 0.96 [95% CI, 0.57-1.59]; or management planning, 1.02 [95% CI, 0.64-1.63]). CONCLUSIONS: A primary care, data-driven quality improvement program did not improve unplanned hospitalizations, MACE, medication prescriptions, achievement of risk factor targets, or management planning for people with CHD. Robust evidence for the use of a data-driven, collaborative approach to improving care for people with CHD in primary care remains elusive. REGISTRATION: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12619001790134.
Authors: Julie Redfern, Nashid Hafiz, Qiang Tu, Andrew Knight, Charlotte Hespe, Clara K. Chow, Tom Briffa, Robyn Gallagher, Christopher M. Reid, David L. Hare, Deborah Manandi, Nicholas Zwar, Mark Woodward, Stephen Jan, Emily R. Atkins, Tracey-Lea Laba, Elizabeth Halcomb, Laurent Billot, Tim Usherwood, Karice Hyun
Institutions: Bond University, The University of Sydney, UNSW Sydney, The University of Notre Dame Australia, Western Sydney Local Health District, The University of Western Australia, Curtin University, Monash University, The University of Melbourne, Austin Hospital, Austin Health, University of Technology Sydney, The George Institute for Global Health, University of Wollongong, Concord Repatriation General Hospital
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
Funders: Amgen, Sanofi, University of Notre Dame, Australian Commission on Safety and Quality in Health Care, Western Sydney Local Health District, National Heart Foundation of Australia, Royal Australian College of General Practitioners, University of New South Wales, University of Sydney, University of Technology Sydney, University of Wollongong, Monash University, Curtin University of Technology, George Institute for Global Health, Medical Research Council, National Health and Medical Research Council, Faculty of Medicine and Health, University of Sydney
Awards: QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease (QUEL), G4194046079, Modernising cardiac rehabilitation and secondary prevention of heart disease, Improving influenza vaccination rate for the prevention of cardiovascular events
OpenAlex ID: W7154454280