{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:10:09Z","timestamp":1756660209941,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"unspecified","delay-in-days":51,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2025,5,5]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Significance and background<\/jats:title>\n                  <jats:p>Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that is associated with an increased cardiovascular (CV) risk.<\/jats:p>\n                  <jats:p>Additional CV risk screening is advised in several national and international guidelines, but is performed inadequately. The CV risk screening in the Netherlands is performed by the general practitioner (GP).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>The aim of our project was to increase the CV risk screening of patients with RA, performed by the GP, from 46% to 65% of the selected patients of 40 years and older, within the time frame of our project (18 months).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>The project was carried out at the outpatient rheumatology clinic at Isala Zwolle, a large teaching hospital, in an area with 106 GP practices. Patients with RA, aged 40 years and older, who did not already participate in a cardiovascular risk management (CVRM) programme in general practice were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>A multicomponent improvement strategy was developed and implemented. A prospective cohort follow-up study was performed, with measurements at T=0, 6, 12, 14, 16 and 18 months. The multicomponent strategy included patient education, a standard CVRM text in the electronic patient record (EPR) as a reminder, an educational meeting about CVRM in general practice for the rheumatologists and nurses, as well as feedback sessions with the rheumatologists, showing current data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In our project, 784 RA patients were included. At time T=0, a CV risk analysis had been performed in the past 5 years in 46.4% of the patients with RA, who were not already participating in a CVRM protocol.<\/jats:p>\n                  <jats:p>This was significantly increased to 55.4% at 18 months in a prospective observational follow-up study. The primary goal, however, was not reached within the time frame of our project.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The availability of patient education cards and the feedback sessions with rheumatologists significantly contributed to the improvement. The implementation of an automatic standard text in the EPR, serving as an electronic reminder, did not perform as well as was anticipated.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjoq-2024-003018","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T04:15:46Z","timestamp":1747973746000},"page":"e003018","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Quality improvement project to improve cardiovascular risk screening in patients with rheumatoid arthritis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3420-8183","authenticated-orcid":false,"given":"Monique","family":"Hoekstra","sequence":"first","affiliation":[{"name":"Rheumatology, Isala, Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harriet","family":"de Vries","sequence":"additional","affiliation":[{"name":"Rheumatology, Isala, Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarinda","family":"van den Bosch-Schreuder","sequence":"additional","affiliation":[{"name":"ICT Data Management, Isala, Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mireille","family":"Edens","sequence":"additional","affiliation":[{"name":"Epidemiology, Isala, Zwolle, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"2025083109421716000_14.2.e003018.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k1036","article-title":"Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications","volume":"361","author":"England","year":"2018","journal-title":"BMJ"},{"key":"2025083109421716000_14.2.e003018.2","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/msc.1196","article-title":"Cardiovascular risk management in rheumatoid arthritis: A large gap to close","volume":"16","author":"Ladak","year":"2018","journal-title":"Musculoskeletal Care"},{"key":"2025083109421716000_14.2.e003018.3","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s10067-019-04901-x","article-title":"Primary care providers\u2019 awareness, knowledge, and practice with regard to cardiovascular risk in patients with rheumatoid arthritis","volume":"39","author":"Pak","year":"2020","journal-title":"Clin Rheumatol"},{"key":"2025083109421716000_14.2.e003018.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209775"},{"key":"2025083109421716000_14.2.e003018.5","unstructured":"NHG standaad cardiovasculair risicomanagement (m84) versie 4.0. 2019."},{"key":"2025083109421716000_14.2.e003018.6","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew039"},{"key":"2025083109421716000_14.2.e003018.7","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1080\/03009742.2019.1600718","article-title":"Suboptimal cardiovascular risk management in rheumatoid arthritis patients despite an explicit cardiovascular risk screening programme","volume":"48","author":"Heslinga","year":"2019","journal-title":"Scand J Rheumatol"},{"key":"2025083109421716000_14.2.e003018.8","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1093\/rheumatology\/kew497","article-title":"Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the Implementation of Cardiovascular Risk Management in Rheumatoid Arthritis project","volume":"56","author":"van den Oever","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"2025083109421716000_14.2.e003018.9","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003485","article-title":"cardiovascular disease risk in patients with inflammatory arthritis nowadays still substantially elevated","volume":"69","author":"Raadsen","year":"2023","journal-title":"RMD Open"},{"key":"2025083109421716000_14.2.e003018.10","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1002\/acr.22966","article-title":"Implementing an Electronic Medical Record-Based Reminder for Cardiovascular Risk Screening in Rheumatoid Arthritis","volume":"69","author":"Akenroye","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025083109421716000_14.2.e003018.11","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212392"},{"key":"2025083109421716000_14.2.e003018.12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.15.1458"},{"key":"2025083109421716000_14.2.e003018.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7185.728"},{"key":"2025083109421716000_14.2.e003018.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-008592","article-title":"Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews","volume":"5","author":"Johnson","year":"2015","journal-title":"BMJ Open"},{"key":"2025083109421716000_14.2.e003018.15","doi-asserted-by":"crossref","first-page":"105276","DOI":"10.1016\/j.ijmedinf.2023.105276","article-title":"Sharpening clinical decision support alert and reminder designs with MINDSPACE: A systematic review","volume":"181","author":"Hashemi","year":"2024","journal-title":"Int J Med Inform"},{"key":"2025083109421716000_14.2.e003018.16","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1093\/ibd\/izab247","article-title":"Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review","volume":"28","author":"Yu","year":"2022","journal-title":"Inflamm Bowel Dis"},{"key":"2025083109421716000_14.2.e003018.17","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/msc.1104","article-title":"Patients\u2019 Experiences of Nurse-Led Screening for Cardiovascular Risk in Rheumatoid Arthritis","volume":"13","author":"Fr\u00f8lund","year":"2015","journal-title":"Musculoskeletal Care"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2024-003018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:42:23Z","timestamp":1756658543000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2024-003018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":17,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,5,22]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bmjoq-2024-003018"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2024-003018","relation":{},"ISSN":["2399-6641"],"issn-type":[{"type":"electronic","value":"2399-6641"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}