IDEAL Study: Overview

The IDEAL study program aims to establish and test the clinical value of a new health service method to deliver patient information on cardiovascular disease (CVD) risk to primary care doctors. It is expected that the new service will be popular for general practitioners (GPs) to use and will result in significantly improved CVD health outcomes as well as reduced health system costs.

There is a major evidence-practice gap in terms of appropriate assessment and treatment of risk for CVD. This gap will be filled in this project by absolute CVD risk being measured at pathology services in patients referred by GPs. Referred patients will have blood pressure (BP) measured and CVD risk factors collated electronically by pathology services using a high-throughput, validated approach, with absolute CVD risk results conveyed to GPs via the established and well regarded pathology reporting system. Abnormal results will be highlighted and advice provided to GPs regarding appropriate action according to guidelines as an aid to improving patient management.

After establishment (phase 1), success of the new health service method will be tested by data linkage to health outcomes among participants assigned to receive the new service compared with usual care in a state-wide cluster randomised controlled trial over years 2 to 5 of the program (phase 2). Qualitative methods will also be used to gauge nuances of patient-GP encounters and refine system processes.

Aims

To establish a new health service method to measure absolute CVD risk within pathology services, and to determine the effectiveness of this new system on:

  1. Incident CVD-related events and CVD-related mortality.
  2. Health care costs.
  3. Doctor and patient experiences.

Hypotheses

Compared with usual care, the new health service method of absolute CVD risk measurement will:

  1. Improve clinical outcomes (CVD-related hospitalisations and mortality).
  2. Reduce health care costs.
  3. Improve doctor and patient experiences.

Significance and innovation

Death and disability from CVD has the highest level of health care expenditure in Australia. This program will build directly on existing infrastructure to produce a novel, yet simple, approach to assessing CVD risk. The program will ultimately stimulate better targeted primary care CVD health service delivery to reduce the community burden and costs related to CVD morbidity and mortality.

The program will be a world first, but is similar to the successful initiative to provide estimated glomerular filtration rate (eGFR) on pathology reports to address chronic kidney disease. While the proposed new model will be developed and tested in Tasmania, the eventual long-term effect will be to improve CVD health service delivery across Australia. Results are expected to be published in the highest impact internal medicine journals worldwide, and the program will influence national and international guidelines.

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