Delivery of Preventive Services in Primary Care - Full Text View

Purpose

The major goal of this project is to determine the effectiveness of a multi-component intervention designed to help primary care practices implement three office system strategies known to increase delivery of immunizations and other preventive services. This two-year study will contribute to our understanding of multi-component translational interventions in primary care, and particularly within practice-based research networks.

Condition	Intervention
Preventive Services Immunizations Screening	Other: Practice intervention Other: Practice intervention 2

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention
Official Title:	Delivery of Preventive Services in Primary Care

Further study details as provided by Agency for Healthcare Research and Quality (AHRQ):

Primary Outcome Measures:

Implementation of one or more of three evidence-based strategies [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Rates of delivery of selected preventive services [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Enrollment:	24
Study Start Date:	October 2004
Study Completion Date:	July 2006
Primary Completion Date:	May 2006 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: 1 Performance feedback, academic detailing, practice facilitation, IT support	Other: Practice intervention Performance feedback, academic detailing, practice facilitation, IT support
Active Comparator: 2 Performance feedback only	Other: Practice intervention 2 Performance feedback only.

Detailed Description:

The multi-component translational intervention that we plan to test includes medical record audits with feedback and benchmarking, academic detailing by an opinion leader including information from literature review plus the advice of local exemplars, a practice facilitator, who will work with the practices over a six-month period, and an IT application that provides decision-support, prompts, and reminders to office staff and patients.

The proposed project will be a randomized controlled trial of a multi-component strategy designed to facilitate the incorporation into primary care practices of three office management components known to increase preventive service delivery rates: 1) nurse standing orders; 2) special immunization/ preventive services "clinics;" and 3) recall and reminder systems. Twenty-four practices, all members of a primary care practice-based research network, will be enrolled and randomized to receive the complete intervention or performance feedback with benchmarking only. The primary outcomes will be number of management components implemented. Characteristics of clinicians and practices that are associated with greater or lesser success in implementing the three strategies and barriers encountered will also be examined, and we will measure and compare rates of selected immunizations and preventive services delivered.

The specific aims for this project are to:

Determine the effectiveness of a multi-component translational intervention on adoption of three strategies known to increase delivery of preventive services: nurse standing orders, a reminder/recall system (preferably PSRS), and special immunization and/or preventive services clinics. The intervention will include: a) performance feedback and benchmarking; b) training of clinicians and office staff in principles of effective preventive services (enhanced academic detailing by a physician opinion leader); c) practice enhancement assistants to facilitate office system changes; and d) an IT application that provides prompts and reminders to office staff, clinicians, and patients.
Document contextual factors and barriers to the adoption of the three strategies and their impact on the intervention.
Measure the impact of the intervention on rates of delivery of the following preventive services: DtaP#4, MMR#1, and HepB#3 in 2-3 year olds, and pneumococcal immunization, colorectal cancer screening, and mammography in adults 50 - 75 years of age.

Eligibility

Ages Eligible for Study:	30 Years to 65 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

Primary care physician
Member of the Oklahoma Physicians Resource/Research Network
Computer with internet connection
More than 30 patients seen per week
Provides care to 2-3 year-olds and/or 50-75 year olds

Exclusion Criteria:

Does not provide preventive services
Inclusion of more than two of the preventive service delivery strategies at baseline
Involved in another network project
Unwilling to work with an external practice facilitator
IRB used by the practice will not allow records audits without individual patient consent

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00115557

Locations

United States, Oklahoma
OKPRN
Oklahoma City, Oklahoma, United States, 73104

Sponsors and Collaborators

Agency for Healthcare Research and Quality (AHRQ)

Investigators

Principal Investigator:

James W Mold, MD, MPH

University of Oklahoma

More Information

No publications provided

Responsible Party:	James Mold, MD, MPH, University of Oklahoma HSC Department of Family and Preventive Medicine
ClinicalTrials.gov Identifier:	NCT00115557 History of Changes
Other Study ID Numbers:	1R21-HS14850
Study First Received:	June 23, 2005
Last Updated:	August 11, 2010
Health Authority:	United States: Federal Government

Keywords provided by Agency for Healthcare Research and Quality (AHRQ):

translational research
prevention
primary care
practice-based research network

ClinicalTrials.gov processed this record on May 16, 2013