Delivery of Preventive Services in Primary Care

NCT ID: NCT00115557

Last Updated: 2010-08-12

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 24 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2004-10-31
• Study Completion Date: 2006-07-31

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.

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.

Conditions

Preventive Services; Immunizations; Screening

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

1

Performance feedback, academic detailing, practice facilitation, IT support

Group Type: EXPERIMENTAL

Practice intervention

Intervention Type: OTHER

Performance feedback, academic detailing, practice facilitation, IT support

2

Performance feedback only

Group Type: ACTIVE_COMPARATOR

Practice intervention 2

Intervention Type: OTHER

Performance feedback only.

Interventions

Practice intervention

Performance feedback, academic detailing, practice facilitation, IT support

Intervention Type: OTHER

Practice intervention 2

Performance feedback only.

Intervention Type: OTHER

Eligibility 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

• Minimum Eligible Age: 30 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role: lead

Responsible Party

University of Oklahoma HSC Department of Family and Preventive Medicine

Principal Investigators

James W Mold, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Oklahoma

Locations

OKPRN

Oklahoma City, Oklahoma, United States

Countries

United States

Other Identifiers

1R21HS014850

Identifier Type: AHRQ

Identifier Source: org_study_id

View Link