The Logic Behind a Multimethod Intervention to Improve Adherence to Clinical Practice Guidelines in a Nationwide Network of Primary Care Practices

Abstract

The gap between evidence-based guidelines for clinical care and their application in medical settings is well established and widely discussed. Effective interventions are needed to help health care providers reduce this gap. Whereas the development of clinical practice guidelines from biomedical and clinical research is an example of Type 1 translation, Type 2 translation involves successful implementation of guidelines in clinical practice. This article describes a multimethod intervention that is part of a Type 2 translation project aimed at increasing adherence to clinical practice guidelines in a nationwide network of primary care practices that use a common electronic medical record (EMR). Practice performance reports, site visits, and network meetings are intervention methods designed to stimulate improvement in practices by addressing personal and organizational factors. Theories and evidence supporting these interventions are described and could prove useful to others trying to translate medical research into practice. Additional theory development is needed to support translation in medical offices.

Using computational modeling to assess the impact of clinical decision support on cancer screening improvement strategies within the community health centers

“…In the low- Δk cluster, the low / low CHC’s presented at the bottom with the lowest 10-year Δk, and the CHC’s ranked low / high displayed only a slightly higher 10-year Δk . These findings were consistent with those observed in previous research where a positive correlation between the rate of organizational learning and some measure of performance/success was asserted [51]. …”

“…Previous studies identified metrics for organizational learning and described them in terms of clinical “know-how” [49], collective intuition [50], and overall organizational learning and/or organizational intelligence [51–54]. The findings derived from these simulations were consistent with previous studies that argued the following: (1) Organizations change over time; (2) a positive correlation exists between the rate of organizational learning and some measure of performance/success; (3) health information technology used in support of cancer outcomes should take into account the learning required to improve organizational capability; and (4) the health care facility should be viewed as a complex adaptive environment [51, 52].…”

Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID)

“…The A-TRIP QI demonstration project was comprised of three specific types of interventions: practice performance reports (audit and feedback), optional semi-annual site visits to practices for academic detailing and participatory planning, and optional annual network meetings to share 'best practice' approaches. The logic and supporting theory of the A-TRIP intervention has been published elsewhere [29]. The purpose of this paper is to summarize the development of a statistically robust and clinically meaningful composite summary measure that would help the research team and individual practices evaluate the overall progress of a QI demonstration project.…”

Atenção primária à saúde: diretrizes, desafios e recomendações. Revisão de bibliografia internacional

“…alguns autores se mostraram entusiastas da MBe, recomendando expressamente sua adoção na aPs (neMetH et al, 2008;FeIFeR et al, 2006), apesar das controvérsias. entretanto, mesmo autores favoráveis à MBe (neMetH et al, 2008) partiram do pressuposto de que os serviços têm grandes dificuldades de implementá-la; de que a qualidade da aPs é muito variável; de que há pouco uso, mal uso ou abuso de diretrizes clínicas e de que a atenção primária à saúde ocorre em sistemas complexos, sem rotina clara, com demandas que competem entre si e com profissionais muitas vezes inertes (desmotivados e com rotinas estereotipadas).…”