Table A3: GRADE Evidence Profile for Process-of-Care Indicators.
| No. of Studies (Design) | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | Upgrade Considerations | Quality |
|---|---|---|---|---|---|---|---|
| BP Measures | |||||||
| 3 (observational) | Very serious limitations (−2)a,b,c | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Total Cholesterol | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 2 (observational) | Serious limitations (−1)a,b | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕Very low |
| Triglycerides | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 2 (observational) | Serious limitations (−1)a,b | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| HbA1c | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 5 (observational) | Serious limitations (−1)a,b,c | No serious limitations | Serious limitations (−1)e | No serious limitations | Undetected | None identified | ⊕ Very low |
| Blood Glucose | |||||||
| 1 (observational) | Serious limitations (−1)a | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Fructosamine | |||||||
| 1 (observational) | Serious limitations (−1)a | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Eye Examinations | |||||||
| 1 (RCT) | Very serious limitations (−2)d | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 5 (observational) | Serious limitations (−1)a,b,c | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Foot Examinations | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 2 (observational) | Serious limitations (−1)b,c | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Kidney Management: Urine Protein | |||||||
| 1 (RCT) | Very serious limitations (−2)d | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 3 (observational) | Serious limitations (−1)a,b,c | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Kidney Management: Creatinine | |||||||
| 1 (observational) | Serious limitations (−1)a | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Kidney Management: Composite Outcome | |||||||
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Kidney Management: Urinalysis | |||||||
| 1 (observational) | Serious limitations (−1)b | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Weight | |||||||
| 1 (observational) | Serious limitations (−1)a | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Height | |||||||
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Vaccinations and immunizations | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 2 (observational) | Serious limitations (−1)b,c | No serious limitations | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: ACE Inhibitors | |||||||
| 2 (observational) | Serious limitations (−1)c | No serious limitations | Serious limitations (−1)e | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: Anticoagulation | |||||||
| 2 (observational) | Serious limitations (−1)c | No serious limitations | Serious limitations (−1)e | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: Aspirin | |||||||
| 2 (observational) | Serious limitations (−1)b,c | No serious limitations | Serious limitations (−1)e | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: Aldosterone Antagonists | |||||||
| 1 (observational) | Serious limitations (−1)a | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: ICD/CRT-D | |||||||
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: Beta-blocker | |||||||
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: CRT-P/CRT-D | |||||||
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Medications: Changes in Statins (1 month) | |||||||
| 1 (RCT) | Serious limitations (−1)f | Not relevant | No serious limitations | Serious limitations (−1)g | Undetected | None identified | ⊕⊕ Low |
| Medications: Changes in Statins (1 year) | |||||||
| 1 (RCT) | Serious limitations (−1)f | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕⊕ Moderate |
| Behavioural Interventions: Diet Advice | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Behavioural Interventions: Smoking Assessment | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| 1 (observational) | Serious limitations (−1)b | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Behavioural interventions: Exercise Advice | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| Behavioural interventions: Self-Management Support | |||||||
| 1 (RCT) | Very serious limitations (−2)d | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕⊕ Low |
| Behavioural Interventions: Heart Failure Education | |||||||
| 1 (observational) | Serious limitations (−1)c | Not relevant | No serious limitations | No serious limitations | Undetected | None identified | ⊕ Very low |
| Composite Outcomes of Tests Conducted or Recorded | |||||||
| 2 (observational) | Serious limitations (−1)a | No serious limitations | Serious limitations (−1)e | No serious limitations | Undetected | None identified | ⊕ Very low |
Abbreviations: ACE inhibitor, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BP, blood pressure; CRT-D, cardio-resynchronization therapy with defibrillator; CRT-P, cardio-resynchronization therapy with pacemaker; ED, emergency department EHR, electronic health record; EMR, electronic medical record; eTool, electronic tool; HbA1c, hemoglobin A1c; ICD, implantable cardioverter defibrillator; No., number; RCT, randomized controlled trial.
a
Physicians with the greatest number of referrals were provided with electronic intervention, while the others were considered the control group.
b
Unknown methodology for selecting practices involved early versus later in the process of rolling out EHR systems.
c
Physicians self-selected to use EMRs (or other eTools), and therefore may inherently be different from those who did not.
d
Physicians to receive intervention were nominated by the study sites through unknown selection methodology. Additional selective reporting bias as authors did not report data for 3 outcomes (hospitalizations, ED visits, and primary care visits).
e
Studies used different measures (e.g., per-patient versus proportion of patients).
f
Physicians had patients in both study groups, contaminating blinding.
g
Wide confidence intervals.