Delivery of Preventive Services in Primary Care

This study has been completed.
Sponsor:
Information provided by:
Agency for Healthcare Research and Quality (AHRQ)
ClinicalTrials.gov Identifier:
NCT00115557
First received: June 23, 2005
Last updated: August 11, 2010
Last verified: September 2007

June 23, 2005
August 11, 2010
October 2004
May 2006   (final data collection date for primary outcome measure)
Implementation of one or more of three evidence-based strategies [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Implementation of one or more of the office based-strategies (standing orders, prompts and reminders, and special prevention clinics/visits)
Complete list of historical versions of study NCT00115557 on ClinicalTrials.gov Archive Site
Rates of delivery of selected preventive services [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Rates of delivery of selected preventive services
Not Provided
Not Provided
 
Delivery of Preventive Services in Primary Care
Delivery of Preventive Services in Primary Care

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.

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:

  1. 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.
  2. Document contextual factors and barriers to the adoption of the three strategies and their impact on the intervention.
  3. 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.
Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
  • Preventive Services
  • Immunizations
  • Screening
  • Other: Practice intervention
    Performance feedback, academic detailing, practice facilitation, IT support
  • Other: Practice intervention 2
    Performance feedback only.
  • Experimental: 1
    Performance feedback, academic detailing, practice facilitation, IT support
    Intervention: Other: Practice intervention
  • Active Comparator: 2
    Performance feedback only
    Intervention: Other: Practice intervention 2
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
24
July 2006
May 2006   (final data collection date for primary outcome measure)

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
Both
30 Years to 65 Years
Yes
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00115557
1R21-HS14850
No
James Mold, MD, MPH, University of Oklahoma HSC Department of Family and Preventive Medicine
Agency for Healthcare Research and Quality (AHRQ)
Not Provided
Principal Investigator: James W Mold, MD, MPH University of Oklahoma
Agency for Healthcare Research and Quality (AHRQ)
September 2007

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP