The Perfect-CR Implementation Study

NCT ID: NCT05889416

Last Updated: 2024-11-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ENROLLING_BY_INVITATION

Clinical Phase

NA

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-01

Study Completion Date

2030-12-31

Brief Summary

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The goal of this open-label cluster-randomized effectiveness-implementation hybrid trial is to study whether a) audit and feedback of cardiac rehabilitation service delivery within a national quality registry and b) structured implementation support can improve center-level adherence to guidelines and short and long-term patient-level outcomes.

Detailed Description

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Administering secondary prevention via structured cardiac rehabilitation (CR) programs for patients who have suffered a myocardial infarction (MI) reduces mortality and morbidity and improves quality of life. Still, treatment goal achievement at patient-level and service delivery at center-level are sub-optimal and there is a large variation in program structure and delivery at center-level.

Using an open-label cluster-randomized effectiveness-implementation hybrid trial design, the primary objective of this study is to prospectively evaluate whether a) audit and feedback of CR processes and structures within the national cardiac registry SWEDEHEART and b) supporting CR centers in implementing CR guidelines can increase center-level guideline adherence. The secondary objectives are the following:

* At baseline, to cross-sectionally evaluate the association between center-level adherence to guidelines and patient-level outcomes
* To prospectively study whether audit and feedback of CR processes and structures within the SWEDEHEART registry can improve short- and long-term patient-level outcomes
* To prospectively evaluate whether supporting CR centers in implementing CR guidelines can improve short- and long-term patient-level outcomes
* To evaluate the acceptability, adoption, fidelity, implementation cost, and cost effectiveness of the implementation support

All CR centers in Sweden (approximately 75 centers) will be offered participation in the study. Collectively these centers attend to approximately 8000 patients/year. Patient-level outcome data will be retrieved from national registries.

Conditions

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Myocardial Infarction Risk Reduction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Open-label Cluster-randomized Effectiveness-implementation Hybrid Trial
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Usual care

Implementation of national guidelines on secondary prevention according to local plan and preferences

Group Type NO_INTERVENTION

No interventions assigned to this group

Audit and feedback

Audit and feedback on implementation of national guidelines on secondary prevention through the national quality registry SWEDEHEART

Group Type ACTIVE_COMPARATOR

Audit and feedback through a quality registry

Intervention Type OTHER

Centres answer CR process and structure variables through the SWEDEHEART registry every six months for three years. Feedback will be accessible online and through annual reports, enabling comparisons with own prior and other centres´ results.

Implementation support

Audit and feedback through the national quality registry SWEDEHEART and structured implementation support for implementation of national guidelines on secondary prevention

Group Type ACTIVE_COMPARATOR

Audit and feedback through a quality registry

Intervention Type OTHER

Centres answer CR process and structure variables through the SWEDEHEART registry every six months for three years. Feedback will be accessible online and through annual reports, enabling comparisons with own prior and other centres´ results.

Implementation support

Intervention Type OTHER

On-site support to implement guidelines on secondary prevention applying practice facilitation - a multifaceted approach carried out by CR experts who enable personnel at intervention centres to address and overcome challenges in implementing guidelines.

Interventions

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Audit and feedback through a quality registry

Centres answer CR process and structure variables through the SWEDEHEART registry every six months for three years. Feedback will be accessible online and through annual reports, enabling comparisons with own prior and other centres´ results.

Intervention Type OTHER

Implementation support

On-site support to implement guidelines on secondary prevention applying practice facilitation - a multifaceted approach carried out by CR experts who enable personnel at intervention centres to address and overcome challenges in implementing guidelines.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Centres report to the SWEDEHEART registry


* Diagnosis of a type 1 MI registered in the SWEDEHEART registry
* Age 18-79 years at discharge from hospital
* Attended at least two follow-up visits at CR centres included in the study

Exclusion Criteria

* Unwillingness to participate in the study

Patient-level


* None
Minimum Eligible Age

18 Years

Maximum Eligible Age

79 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Lund University

OTHER

Sponsor Role collaborator

Uppsala University

OTHER

Sponsor Role collaborator

Skane University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Margret Leosdottir

Senior Cardiology Consultant, Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Margret Leosdottir

Role: PRINCIPAL_INVESTIGATOR

Skane University Hospital Malmö

Locations

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Skåne University Hospital

Malmo, , Sweden

Site Status

Countries

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Sweden

References

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Michelsen HO, Lidin M, Back M, Duncan TS, Ekman B, Hagstrom E, Hagglund M, Lindahl B, Schlyter M, Leosdottir M. The effect of audit and feedback and implementation support on guideline adherence and patient outcomes in cardiac rehabilitation: a study protocol for an open-label cluster-randomized effectiveness-implementation hybrid trial. Implement Sci. 2024 May 24;19(1):35. doi: 10.1186/s13012-024-01366-8.

Reference Type DERIVED
PMID: 38790045 (View on PubMed)

Other Identifiers

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Perfect-CR V2.0 2023

Identifier Type: -

Identifier Source: org_study_id