Period: 2018-2019

Researchers: Vilma Irazola, Ezequiel García Elorrio, Inés Suárez Anzorena, Martín Chaparro

 Goal

To evaluate the effectiveness of a multicomponent collaborative intervention to improve the counterreferral process of patients with heart failure, arterial hypertension and/or coronary heart disease in the public health care system.

Summary

This study is a pragmatic cluster-randomized clinical trial that combines a participatory and dynamic methodology based on improvement cycles.

10 hospitals from the second level of care will be selected: 5 will be randomly assigned to receive an intervention to increase effective counterreferral (improvement cycles) and 5 to the control arm (usual strategies). The study will be carried out in the programmatic area of ​​selected hospitals in the provinces of Mendoza, Salta and Tucumán. Patients who have been hospitalized with a diagnosis of heart failure, high blood pressure or coronary heart disease will be included. 51 patients per hospital will be included, in total, 510 participants.

In the intervention branch, at least 3 learning sessions will be carried out with the members of the care system, in order to identify opportunities for improvement aimed at the design and application of an innovative intervention based on best practices.

The primary outcomes that will be measured are: 1) time until the first consultation at the CAPS after hospital discharge; 2) readmissions; 3) re-consultation at the hospital; 4) monitoring in the CAPS; 5) satisfaction with the care received; 6) experience of health care providers.

It is expected to develop an intervention that allows the public health sector to have effective and validated strategies in the local context, which make the counter-referral system for patients with chronic diseases such as coronary heart disease, high blood pressure and heart failure more effective.

Financing

IDB – Inter-American Development Bank.

Type of study

Pragmatic cluster randomized clinical trial (clusters).