Delivery of Preventive Services in Primary Care

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00115557
Recruitment Status : Completed
First Posted : June 24, 2005
Last Update Posted : August 12, 2010
Information provided by:
Agency for Healthcare Research and Quality (AHRQ)

Brief Summary:
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 or disease Intervention/treatment Phase
Preventive Services Immunizations Screening Other: Practice intervention Other: Practice intervention 2 Not Applicable

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:

  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.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 24 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Delivery of Preventive Services in Primary Care
Study Start Date : October 2004
Actual Primary Completion Date : May 2006
Actual Study Completion Date : July 2006

Arm Intervention/treatment
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.

Primary Outcome Measures :
  1. Implementation of one or more of three evidence-based strategies [ Time Frame: 6 months ]

Secondary Outcome Measures :
  1. Rates of delivery of selected preventive services [ Time Frame: 6 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   30 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00115557

United States, Oklahoma
Oklahoma City, Oklahoma, United States, 73104
Sponsors and Collaborators
Agency for Healthcare Research and Quality (AHRQ)
Principal Investigator: James W Mold, MD, MPH University of Oklahoma

Responsible Party: James Mold, MD, MPH, University of Oklahoma HSC Department of Family and Preventive Medicine Identifier: NCT00115557     History of Changes
Other Study ID Numbers: 1R21HS014850 ( U.S. AHRQ Grant/Contract )
First Posted: June 24, 2005    Key Record Dates
Last Update Posted: August 12, 2010
Last Verified: September 2007

Keywords provided by Agency for Healthcare Research and Quality (AHRQ):
translational research
primary care
practice-based research network