Format

Send to:

Choose Destination
See comment in PubMed Commons below
Pediatrics. 2014 Sep;134(3):e732-8. doi: 10.1542/peds.2014-0876.

Adoption of cardiovascular risk reduction guidelines: a cluster-randomized trial.

Author information

  • 1RTI International Waltham, Massachusetts; klabresh@rti.org.
  • 2Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, Illinois; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
  • 3Brody School of Medicine, Departments of Pediatrics and Public Health, East Carolina University, Greenville North Carolina;
  • 4RTI International Waltham, Massachusetts;
  • 5Brody School of Medicine, Departments of Pediatrics and Public Health, East Carolina University, Greenville North Carolina; Public Health Institute, Research and Evaluation Section Nutrition Education and Obesity Prevention Branch, California Department of Public Health, Sacramento, California; and.
  • 6National Heart, Lung, and Blood Institute, Bethesda, Maryland.
  • 7Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
  • 8Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, Illinois;

Abstract

BACKGROUND AND OBJECTIVES:

Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children.

METHODS:

Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared.

RESULTS:

The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01).

CONCLUSIONS:

Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01893593.

Copyright © 2014 by the American Academy of Pediatrics.

KEYWORDS:

cardiovascular disorders; children; cluster randomized trial; guideline implementation; prevention; quality improvement

PMID:
25157013
[PubMed - indexed for MEDLINE]
PMCID:
PMC4144001
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk