Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF)
Optimal care of AF patients is also hindered by large gaps between usual care and best care. For example, a large proportion of AF patients at moderate to high risk for stroke do not receive guideline recommended thromboprophylaxis; and of those that do, many are not optimally controlled. A patient-centered and community-focused management program (IMPACT-AF) is developed to determine if patients with AF can be managed as effectively (clinical outcomes) and more efficiently (economic outcomes) in primary care as they are in specialized care. The premise of IMPACT-AF is that primary care providers within the community when supported by an electronic AF patient management system that offers: a) clinical decision aids based on clinical guidelines for AF; and, b) a communication medium for data sharing and referrals, with the specialized AF management centre in Halifax, will lead to improved diagnosis and standardized disease management, including increased use of proven therapies for AF rhythm and rate management, and better stroke prevention. The primary outcome is a decrease in CV hospitalizations, with secondary outcomes of clinical, process of care and economic relevance. The cluster-randomized study design will permit measurement and comparison of the clinical decision support system pre and post intervention, and across cases. A principal assumption is that IMPACT-AF will build on the principles and practices of benchmark disease management projects like ICONS, particularly in aligning with provincial and regional health policies that direct support to primary care and data management resources that address public health burdens. We anticipate that IMPACT-AF will successfully extend a more clinically effective, cost-efficient and sustainable social-networking model of health management to a segment of our aging population who need things to be better. In doing so, IMPACT-AF will also produce, markedly improved stakeholder outcomes and satisfaction – all of which can be modeled in other areas of health care priority.
Dr. Jafna Cox is the principal investigator of this study. Feng is a co-investigator and leader in the economic evaluation.