Implementation of evidence-based preventive services delivery processes in primary care: an Oklahoma Physicians Resource/Research Network (OKPRN) study
Open accessAbstract
BACKGROUND: Previous research has found that wellness visits, recall and reminder systems, and standing orders are associated with higher rates of delivery of preventive services in primary care practices. However, there is little information about how to help practices implement these processes. METHODS: A 6-month randomized, controlled trial comparing a multicomponent quality improvement intervention to feedback and benchmarking. One clinician/nurse team from each of 24 practices was randomly assigned to one of 2 study arms. Intervention practices received performance feedback, peer-to-peer education (academic detailing), a practice facilitator, and computer (information technology) support. Implementation of the 3 targeted processes was determined by a blinded 3-clinician panel that reviewed transcribed clinician interviews before and after intervention using performance definitions. Rates of delivery of selected preventive services were determined by chart audit. RESULTS: Intervention practices implemented more of the processes than control practices overall (P = .003), for adults (P = .05), and for children (P = .04). They were also more likely to implement at least one of the processes for children (P = .04) and to implement standing orders for either children or adults (P = .02). Mammography rates increased significantly. Neither clinician and practice characteristics nor clinician readiness to change predicted implementation. CONCLUSIONS: A multicomponent implementation strategy consisting of feedback, benchmarking, academic detailing, facilitation, and IT support increased implementation of evidence-based processes for delivering preventive services to a greater extent than performance feedback and benchmarking alone.
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Mold 2008 found that these efforts translated into a statistically significant improvement in only one of six preventive services measured (median adjusted RD = 8%, no overall P value reported).
“but these efforts translated into a statistically significant improvement in only one of six preventive services measured (median adjusted RD = 8%, no overall P value reported)”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Mold 2008
Mold 2008 found that academic detailing led to increased implementation of a variety of quality improvement processes in primary care (e.g. standardised protocols).
“Mold 2008 found that academic detailing led to increased implementation of a variety of quality improvement processes in primary care (e.g. standardised protocols)”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Mold 2008
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- Authors
- Mold, J. W., Aspy, C. A., & Nagykaldi, Z.
- Affiliations
- University of Oklahoma Health Sciences Center (US)
- ORCID
- Nagykaldi, Z.
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2008-07-01
- Volume
- 21
- Issue
- 4
- Pages
- 334-344
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2099758423
- Cited by
- 61
- References
- 55
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 2 · 2021: 1 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 4 · 2013: 4 · 2012: 9
- FWCI
- 10.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (5 R21 HS041850-02)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- preventive services, primary care, evidence-based practice implementation, wellness visits, procedural rules, performance feedback, benchmarking, academic detailing, practice facilitation, IT support, mammography, quality improvement intervention
- MeSH terms
- Adult, Aged, Child, Preschool, Female, Humans, Male, Middle Aged, Oklahoma, Practice Patterns, Physicians', Preventive Health Services, Primary Health Care, Quality Assurance, Health Care, Community Networks, Evidence-Based Medicine, Benchmarking
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