Population impact of a high cardiovascular risk management program delivered by village doctors in rural China: design and rationale of a large, cluster-randomized controlled trial.
Population impact of a high cardiovascular risk management program delivered by village doctors in rural China: design and rationale of a large, cluster-randomized controlled trial.
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DOI：
10.1186/1471-2458-14-345
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发表时间：
2014-04-11
影响因子：
4.5
通讯作者：
Wu Y
中科院分区：
文献类型：
--
作者：
Yan LL;Fang W;Delong E;Neal B;Peterson ED;Huang Y;Sun N;Yao C;Li X;MacMahon S;Wu Y
高风险策略已被证明在预防心血管疾病方面是有效的;然而，这些干预措施对人群的益处仍然未知。本研究的目的是在人群水平上评估由乡村医生提供的循证心血管高危管理项目的效果。本研究将采用整群随机对照试验，将中国北方五省的120个村庄分为干预组（60个村庄）和对照组（60个村庄）。干预村的乡村医生将接受培训，以实施一项简单的循证管理计划，旨在识别、治疗和随访该村尽可能多的心血管疾病高危人群。干预措施还将包括绩效反馈以及基于绩效的奖励支付计划，并将持续2年。我们将在干预前和干预后抽取两个不同的（独立的）随机样本，每个样本中每个村庄有20名年龄≥ 50岁的男性和20名年龄≥60岁的女性，两个样本共9，600名参与者，以测量人群水平的研究结果。主要结局将是平均收缩压的前后差异，使用线性回归模型的广义估计方程扩展进行分析，以解释群集效应。次要结局将包括每月门诊访视、提供生活方式建议、使用抗高血压药物和使用阿司匹林。还将进行工艺和经济评估。该试验将是世界上第一个评估预防和控制心血管疾病高危策略对人群影响的实施试验。研究结果将为中国农村和其他资源有限的国家提供重要的信息（有效性、成本效益、可行性和可接受性），以指导政策制定。该试验在ClinicalTrials.gov（NCT 01259700）上注册。首次注册日期为2010年12月13日。
The high-risk strategy has been proven effective in preventing cardiovascular disease; however, the population benefits from these interventions remain unknown. This study aims to assess, at the population level, the effects of an evidence-based high cardiovascular risk management program delivered by village doctors in rural China. The study will employ a cluster-randomized controlled trial in which a total of 120 villages in five northern provinces of China, will be assigned to either intervention (60 villages) or control (60 villages). Village doctors in intervention villages will be trained to implement a simple evidence-based management program designed to identify, treat and follow-up as many as possible individuals at high-risk of cardiovascular disease in the village. The intervention will also include performance feedback as well as a performance-based incentive payment scheme and will last for 2 years. We will draw two different (independent) random samples, before and after the intervention, 20 men aged ≥ 50 years and 20 women aged ≥60 years from each village in each sample and a total of 9,600 participants from 2 samples to measure the study outcomes at the population level. The primary outcome will be the pre-post difference in mean systolic blood pressure, analyzed with a generalized estimating equations extension of linear regression model to account for cluster effect. Secondary outcomes will include monthly clinic visits, provision of lifestyle advice, use of antihypertensive medications and use of aspirin. Process and economic evaluations will also be conducted. This trial will be the first implementation trial in the world to evaluate the population impact of the high-risk strategy in prevention and control of cardiovascular disease. The results are expected to provide important information (effectiveness, cost-effectiveness, feasibility and acceptability) to guide policy making for rural China as well as other resource-limited countries. The trial is registered at ClinicalTrials.gov (NCT01259700). Date of initial registration is December 13, 2010.
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影响因子：
168.9
作者：
Dumont, Alexandre;Fournier, Pierre;Fraser, William D.
通讯作者：
Fraser, William D.
DOI：
10.1016/s0140-6736(12)61729-2
发表时间：
2012-12-15
期刊：
Lancet (London, England)
影响因子：
--
作者：
Vos T;Flaxman AD;Naghavi M;Lozano R;Michaud C;Ezzati M;Shibuya K;Salomon JA;Abdalla S;Aboyans V;Abraham J;Ackerman I;Aggarwal R;Ahn SY;Ali MK;Alvarado M;Anderson HR;Anderson LM;Andrews KG;Atkinson C;Baddour LM;Bahalim AN;Barker-Collo S;Barrero LH;Bartels DH;Basáñez MG;Baxter A;Bell ML;Benjamin EJ;Bennett D;Bernabé E;Bhalla K;Bhandari B;Bikbov B;Bin Abdulhak A;Birbeck G;Black JA;Blencowe H;Blore JD;Blyth F;Bolliger I;Bonaventure A;Boufous S;Bourne R;Boussinesq M;Braithwaite T;Brayne C;Bridgett L;Brooker S;Brooks P;Brugha TS;Bryan-Hancock C;Bucello C;Buchbinder R;Buckle G;Budke CM;Burch M;Burney P;Burstein R;Calabria B;Campbell B;Canter CE;Carabin H;Carapetis J;Carmona L;Cella C;Charlson F;Chen H;Cheng AT;Chou D;Chugh SS;Coffeng LE;Colan SD;Colquhoun S;Colson KE;Condon J;Connor MD;Cooper LT;Corriere M;Cortinovis M;de Vaccaro KC;Couser W;Cowie BC;Criqui MH;Cross M;Dabhadkar KC;Dahiya M;Dahodwala N;Damsere-Derry J;Danaei G;Davis A;De Leo D;Degenhardt L;Dellavalle R;Delossantos A;Denenberg J;Derrett S;Des Jarlais DC;Dharmaratne SD;Dherani M;Diaz-Torne C;Dolk H;Dorsey ER;Driscoll T;Duber H;Ebel B;Edmond K;Elbaz A;Ali SE;Erskine H;Erwin PJ;Espindola P;Ewoigbokhan SE;Farzadfar F;Feigin V;Felson DT;Ferrari A;Ferri CP;Fèvre EM;Finucane MM;Flaxman S;Flood L;Foreman K;Forouzanfar MH;Fowkes FG;Franklin R;Fransen M;Freeman MK;Gabbe BJ;Gabriel SE;Gakidou E;Ganatra HA;Garcia B;Gaspari F;Gillum RF;Gmel G;Gosselin R;Grainger R;Groeger J;Guillemin F;Gunnell D;Gupta R;Haagsma J;Hagan H;Halasa YA;Hall W;Haring D;Haro JM;Harrison JE;Havmoeller R;Hay RJ;Higashi H;Hill C;Hoen B;Hoffman H;Hotez PJ;Hoy D;Huang JJ;Ibeanusi SE;Jacobsen KH;James SL;Jarvis D;Jasrasaria R;Jayaraman S;Johns N;Jonas JB;Karthikeyan G;Kassebaum N;Kawakami N;Keren A;Khoo JP;King CH;Knowlton LM;Kobusingye O;Koranteng A;Krishnamurthi R;Lalloo R;Laslett LL;Lathlean T;Leasher JL;Lee YY;Leigh J;Lim SS;Limb E;Lin JK;Lipnick M;Lipshultz SE;Liu W;Loane M;Ohno SL;Lyons R;Ma J;Mabweijano J;MacIntyre MF;Malekzadeh R;Mallinger L;Manivannan S;Marcenes W;March L;Margolis DJ;Marks GB;Marks R;Matsumori A;Matzopoulos R;Mayosi BM;McAnulty JH;McDermott MM;McGill N;McGrath J;Medina-Mora ME;Meltzer M;Mensah GA;Merriman TR;Meyer AC;Miglioli V;Miller M;Miller TR;Mitchell PB;Mocumbi AO;Moffitt TE;Mokdad AA;Monasta L;Montico M;Moradi-Lakeh M;Moran A;Morawska L;Mori R;Murdoch ME;Mwaniki MK;Naidoo K;Nair MN;Naldi L;Narayan KM;Nelson PK;Nelson RG;Nevitt MC;Newton CR;Nolte S;Norman P;Norman R;O'Donnell M;O'Hanlon S;Olives C;Omer SB;Ortblad K;Osborne R;Ozgediz D;Page A;Pahari B;Pandian JD;Rivero AP;Patten SB;Pearce N;Padilla RP;Perez-Ruiz F;Perico N;Pesudovs K;Phillips D;Phillips MR;Pierce K;Pion S;Polanczyk GV;Polinder S;Pope CA 3rd;Popova S;Porrini E;Pourmalek F;Prince M;Pullan RL;Ramaiah KD;Ranganathan D;Razavi H;Regan M;Rehm JT;Rein DB;Remuzzi G;Richardson K;Rivara FP;Roberts T;Robinson C;De Leòn FR;Ronfani L;Room R;Rosenfeld LC;Rushton L;Sacco RL;Saha S;Sampson U;Sanchez-Riera L;Sanman E;Schwebel DC;Scott JG;Segui-Gomez M;Shahraz S;Shepard DS;Shin H;Shivakoti R;Singh D;Singh GM;Singh JA;Singleton J;Sleet DA;Sliwa K;Smith E;Smith JL;Stapelberg NJ;Steer A;Steiner T;Stolk WA;Stovner LJ;Sudfeld C;Syed S;Tamburlini G;Tavakkoli M;Taylor HR;Taylor JA;Taylor WJ;Thomas B;Thomson WM;Thurston GD;Tleyjeh IM;Tonelli M;Towbin JA;Truelsen T;Tsilimbaris MK;Ubeda C;Undurraga EA;van der Werf MJ;van Os J;Vavilala MS;Venketasubramanian N;Wang M;Wang W;Watt K;Weatherall DJ;Weinstock MA;Weintraub R;Weisskopf MG;Weissman MM;White RA;Whiteford H;Wiersma ST;Wilkinson JD;Williams HC;Williams SR;Witt E;Wolfe F;Woolf AD;Wulf S;Yeh PH;Zaidi AK;Zheng ZJ;Zonies D;Lopez AD;Murray CJ;AlMazroa MA;Memish ZA
通讯作者：
Memish ZA
影响因子：
37.8
作者：
Wu, Yangfeng;Huxley, Rachel;Yang, Xiaoguang
通讯作者：
Yang, Xiaoguang
影响因子：
168.9
作者：
Lozano, Rafael;Naghavi, Mohsen;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
8.3
作者：
Jauch, Edward C.;Saver, Jeffrey L.;Yonas, Howard
通讯作者：
Yonas, Howard