A real-world stepped wedge cluster randomized trial of practice facilitation to improve cardiovascular care

Liddy, Clare; Hogg, William; Singh, Jatinderpreet; Taljaard, Monica; Russell, Grant; Deri Armstrong, Catherine; Akbari, Ayub; Dahrouge, Simone; Grimshaw, Jeremy M.

doi:10.1186/s13012-015-0341-y

Implementation Science

Table 2 Results from multivariable mixed-effect regression analyses of the effect of the IDOCC intervention

From: A real-world stepped wedge cluster randomized trial of practice facilitation to improve cardiovascular care

Parameter	Model A			Model B			Model C
	(Unadjusted)			(Adjusted for patient factors)			(Adjusted for patient/provider factors)
	Estimate^a	P value	95 % CI	Estimate^a	P value	95 % CI	Estimate^a	P value	95 % CI
Intercept	61.4	<0.0001	56.7 to 66.1	39.2	<0.0001	32.6 to 45.9	44.97	<0.0001	34.8 to 55.1
Time
Year 1	Ref	-	-	Ref	-	-	Ref	-	-
Year 2	1.5	<0.0001	0.8 to 2.3	0.9	0.02	0.2 to 1.7	0.9	0.019	0.2 to 1.7
Year 3	4.2	<0.0001	3.2 to 5.3	3.0	<0.0001	1.9 to 4.0	3.0	<0.0001	1.9 to 4.0
Year 4	6.3	<0.0001	4.6 to 7.9	4.4	<0.0001	2.8 to 6.0	4.4	<0.0001	2.8 to 6.0
Year 5	7.3	<0.0001	5.1 to 9.5	4.9	<0.0001	0.027 to 0.071	4.9	<0.0001	2.7 to 7.1
Intervention phase
Baseline	Ref	-	-	Ref	-	-	Ref	-	-
Intensive	−2.1	<0.0001	−3.2 to −1.1	−1.9	0.0003	−2.9 to −0.9	−1.9	0.0003	−2.9 to −0.9
Sustainability	−4.7	<0.0001	−6.2 to −3.2	−4.2	<0.0001	−5.7 to −2.6	−4.2	<0.0001	−5.7 to −2.6
Region
Region 1	Ref	-	-	Ref	-	-	1.0	0.789	−6.6 to 8.7
Region 2	1.1	0.756	−5.9 to 8.1	1.4	0.695	−5.5 to 8.3	4.1	0.25	−2.9 to 11.0
Region 3	3.8	0.205	−2.1 to 9.7	3.5	0.24	−2.3 to 9.3	2.7	0.531	−5.7 to 11.0
Region 4	2.4	0.535	−5.3 to 10.2	2.3	0.545	−5.3 to 9.9	0.2	0.956	−6.7 to 7.1
Region 5	2.4	0.441	−3.6 to 8.3	0.8	0.780	−5.1 to 6.8	3.7	0.293	−3.2 to 10.6
Region 6	4.5	0.157	−1.7 to 10.7	3.7	0.231	−2.4 to 9.9	5.4	0.184	−2.6 13.4
Region 7	5.7	0.121	−1.5 to 13.0	5.7	0.116	−1.4 to 12.9	Ref	-	-
Region 8	−1.3	0.745	−9.0 to 6.4	−1.0	0.798	−8.6 to 6.6	4.8	0.189	−2.4 to 12.1
Region 9	2.3	0.454	−3.7 to 8.3	2.2	0.476	−3.9 to 8.1	2.1	0.576	−5.1 to 9.2
Patient level
Age				0.03	0.168	−0.01 to 0.06	0.03	0.14	−0.009 to 0.07
Sex				0.09	0.825	−0.7 to 0.9	0.07	0.872	−0.8 to 0.9
Income				0.39	0.004	0.1 to 0.7	0.4	0.0035	0.13 to 0.67
# of cardiovascxular-related diseases^b
0 (risk factors Only)				Ref	-	-	Ref	-	-
1				4.8	<0.0001	3.9 to 5.8	4.8	<0.0001	3.9 to 5.8
2				6.9	<0.0001	5.7 to 8.0	6.9	<0.0001	5.7 to 8.0
3				6.6	<0.0001	5.1 to 8.1	6.6	<0.0001	5.1 to 8.2
4				7.4	<0.0001	4.9 to 9.9	7.4	<0.0001	4.9 to 9.9
5				11.0	0.001	4.3 to 17.6	11.0	0.0012	4.4 to 17.6
# of risk factors for cardiovascular disease^c
0				Ref	-	-	Ref	-	-
1				6.5	0.0009	2.6 to 10.3	6.5	0.0009	2.6 to 10.3
2				12.7	<0.0001	9.0 to 16.4	12.7	<0.0001	8.9 to 16.4
3				17.1	<0.0001	13.4 to 20.9	17.1	<0.0001	13.4 to 20.9
4				4.7	0.017	0.8 to 8.5	4.6	0.019	0.8 to 8.5
Rural				0.0099	0.103	−0.2 to 2.2	0. 9	0.141	−0. 3 to 2.1
Provider level
Payment model
FFS							Ref	-	-
Capitation							1.4	0.437	−2.1 to 4.9
Salary							9.0	0.710	−3.7 to 5.5
Female physician							1.7	0.320	−1.6 to 5.0
Years since graduation (as of 2010)							−0.27	0.0015	−0.4 to −0.1

^aNegative estimate indicates a decrease in adherence
^bCardiovascular-related diseases examined: stroke, coronary artery disease, peripheral vascular disease, diabetes, chronic kidney disease
^cRisk factors assessed were age, hypertension, dyslipidemia, and smoking

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