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Internet-based intervention failed to improve patient care after MI
Levine DA. Arch Intern Med. 2011;171:1910-1917.
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A provider-directed, Internet-delivered intervention improved only one of seven indicators of CV management for ambulatory post-MI patients, according to results of a recent study.
Researchers collected administrative data on 15,847 post-MI patients from 168 community-based primary care clinics and 847 providers between January 2002 and December 2008. All patients were included in the Department of Veterans Affairs MI-Plus study. Patients were randomly assigned to a control clinic or to an intervention clinic, which utilized a multicomponent, Internet-delivered intervention comprising quarterly educational modules, practice guidelines, monthly literature summaries and automated email reminders delivered to providers for 27 months. Main outcome measures included the percentage of patients who achieved each of seven clinical indicators of post-MI monitoring, treatment and target goals:
- LDL assessment in previous 18 months.
- LDL assessment in previous 18 months.
- LDL assessment in previous 18 months.
- HbA1c assessment in previous 18 months.
- Beta-blocker use.
- Statin use.
- ACE inhibitor or angiotensin II receptor blocker use.
- LDL levels <100 mg/dL.
- HbA1c levels <8% in patients with diabetes.
During the course of the study, improvements in care were slightly greater in intervention clinics vs. control clinics for all outcome measures, the researchers reported. Greater improvements were found among patients prescribed beta-blockers in intervention clinics (from 70% to 85.5%) vs. patients in control clinics (71.9% to 84%; adjusted improvement gain=2.6%; 95% CI, 0.1-4.1). Among patients in intervention clinics, five of six remaining clinical indicators and levels of LDL and HbA1c were associated with nonsignificant differences in improvements.
“These findings were observed in small and large and in rural and urban clinics and persisted after adjustment for patient demographics and comorbidity,” the researchers said. “Still, our intervention improved only one of the studied process measures.”
Reasons cited may be related to the high baseline performance of patients, which may have limited efforts to further improve performance, and low-intervention fidelity at some intervention clinics, they said.
“Light-touch educational interventions may improve quality less effectively when baseline performance is high or when targeting a complex set of process measures,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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