RESEARCH ARTICLE Effectiveness of Improvement Plans in Primary Care Practice Accreditation: A Clustered Randomized Trial

Background: Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM). Method: A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n522) were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n523) could focus on any domain except on CVRMand diabetesmellitus. Primary outcomes were systolic blood pressure,140 mmHg, LDL cholesterol,2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician’s perceived goal attainment for the chosen improvement project. Results: No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8 % of patients in the intervention and 38.7 % of patients in th