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Original Investigation
Health Care Reform
Sep 12, 2011

Collaborative Care Intervention for Stable Ischemic Heart Disease

Author Affiliations

Author Affiliations: Departments of Medicine (Drs Fihn, Nelson, and Bryson), Biostatistics (Dr Diehr), and Biobehavioral Nursing and Health Systems (Dr Dougherty), University of Washington, and Virginia Mason Medical Center, Department of Primary Care (Dr Bucher), and Veterans Affairs (VA) Puget Sound Health Care System (Drs Bucher, Diehr, Dougherty, Nelson, Stadius, and Bryson and Ms McDonell), Seattle; VA Eastern Colorado Health Care System, University of Colorado, Denver (Drs Rumsfeld, McBryde, and Plomondon); Portland VA Medical Center and Department of Medicine, Oregon Health and Sciences University, Portland (Drs Doak, Gerrity, Larsen, and Lucas); and VA Palo Alto Health Care System and Department of Medicine, Stanford University, Palo Alto, California (Drs Heidenreich and Lee). Dr Fihn and Ms McDonell are now with the Office of Informatics and Analytics, Veterans Health Administration, Washington, DC.

Arch Intern Med. 2011;171(16):1471-1479. doi:10.1001/archinternmed.2011.372
Abstract

Background Accumulating evidence suggests that collaborative models of care enhance communication among primary care providers, improving quality of care and outcomes for patients with chronic conditions. We sought to determine whether a multifaceted intervention that used a collaborative care model and was directed through primary care providers would improve symptoms of angina, self-perceived health, and concordance with practice guidelines for managing chronic stable angina.

Methods We conducted a prospective trial, cluster randomized by provider, involving patients with symptomatic ischemic heart disease recruited from primary care clinics at 4 academically affiliated Department of Veterans Affairs health care systems. Primary end points were changes over 12 months in symptoms on the Seattle Angina Questionnaire, self-perceived health, and concordance with practice guidelines.

Results In total, 183 primary care providers and 703 patients participated in the study. Providers accepted and implemented 91.6% of 701 recommendations made by collaborative care teams. Almost half were related to medications, including adjustments to β-blockers, long-acting nitrates, and statins. The intervention did not significantly improve symptoms of angina or self-perceived health, although end points favored collaborative care for 10 of 13 prespecified measures. While concordance with practice guidelines improved 4.5% more among patients receiving collaborative care than among those receiving usual care (P < .01), this was mainly because of increased use of diagnostic testing rather than increased use of recommended medications.

Conclusion A collaborative care intervention was well accepted by primary care providers and modestly improved receipt of guideline-concordant care but not symptoms or self-perceived health in patients with stable angina.

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